Investigacin original / Original

research

Factors associated with hepatitis C

seropositivity in people living with HIV
Valdete M. Kuehlkamp, Ione J. C. Schneider, Marcela F. Biudes, 1
Dayani Galato, 1 Jane da Silva, 1 Rosemeri Maurici,1 Jefferson Traebert, 1
1
and Fabiana Schuelter-Trevisol
1

Suggested citation

abstract

Kuehlkamp VM, Schneider IJC, Biudes MF, Galato D, da Silva J, Maurici R, et al. Factors associated
with hepatitis C seropositivity in people living with HIV. Rev Panam Salud Publica. 2014;35(1):539.

Objective. To identify risk factors associated with hepatitis C virus (HCV) seropositivity in
human immunodeficiency virus (HIV)-infected patients.
Methods. A paired case-control study adjusted by age and gender was conducted. It included
adults coinfected with HIV and HCV (cases) and HIV mono-infected subjects (controls) using
non-probability sampling. Data were collected through interviews and review of medical records.
The chi-square test was used for comparing categorical variables and the Students t-test or
Wilcoxon (MannWhitney U) test for continuous variables. Confidence intervals (95%) were
estimated along with crude and adjusted odds ratios using conditional logistic regression.
Results. A total of 165 patients were surveyed, including 55 cases and 110 controls. The mean
age was 43.6 8.4 years, ranging from 19 to 64 years; 70.9% were male. Independent risk factors
for HIV/HCV coinfection were education (up to eight years of schooling); age at first intercourse <
15 years; having undergone tattooing; blood transfusion; and use of injecting drugs.
Conclusions. Low level of education, early age at first sexual intercourse, tattooing, blood
transfusions, and sharing needles and other drug injection equipment were factors that increased the
risk of HIV/HCV coinfection. The results from this research can be compared with similar data from
other regions to help direct preventive and educational efforts targeting people living with HIV.

Key words

Risk factors; hepatitis C; HIV; coinfection; case-control studies; Brazil.

Patients infected with the human imdental contact with contaminated blood.
ing from 3.3% (serum samples) to 82.4%
munodeficiency virus (HIV) may be
Coinfection is a severe clinical condition for (drug users) in studies carried out in Brazil
coinfected with hepatitis C virus (HCV)
both viral diseases (2). It is estimated that on HIV-infected individuals (6). Intravenous
because of the similar transmission routes of one-third of people living with HIV are
drug use ranks first in HCV transmission
both etiologic agents (1), includ- ing sexual coinfected with HCV worldwide (3). The
and HIV/HCV coin- fection in Brazil, and
activity, blood transfusions, mother-to-child prevalence of HIV/ HCV coinfection is high,the data indicate that, among the confirmed
transmission, and acciwith 13 times greater risk in HIV patients cases of hepa- titis C, 30% are associated
(4). Between 2007 and 2010, the HIV/HCV with this practice (5, 6). The prevalence of
1 Programa de Ps-Graduao em Cincias da Sade,
Universidade do Sul de Santa Catarina, Tubaro, Santa coinfec- tion rate was as high as 11.4% of the HIV infection was found to be 5.9% related
Catarina, Brazil. Send correspondence to: Fabiana
total reported cases of AIDS in Brazil (5). In to this transmission route (7). HIV/HCV
fastrevisol@gmail.com
2Schuelter-Trevisol,
Curso de Graduao
em Medicina, Universidade do Sul a recent review of HIV/HCV coinfection, a coinfection is a risk factor for liver fibrosis.
de Santa Catarina, Tubaro, Santa Catarina, Brazil.
prevalence of 20.3% was found, rangHIV seropositivity and
Rev Panam Salud Publica 35(1), 2014 53

low
lymphocyte
CD4+ 3 count seem to accelerate this
in the study by the research or medical team procedures such as endoscopy, surgery,
process (8, 9). Similarly, HCV infection has were excluded from the study. HIV/HCV- exposure to contaminated sharps, and
been shown to be as- sociated with more
coinfected patients were considered cases, injections done by unlicensed persons). In
rapid progression to AIDS (10). HIV/HCV and HIVmono- infected persons were
addition, a documentary analysis of medical
coinfection is a leading cause of morbidity considered con- trols. The diagnosis of HIV records was performed to collect clinical data
and mortality world- wide. The complexity ofinfection was defined by laboratory evidenceand laboratory test results. The collected
the data that must be analyzed to determine with the use of two screening tests in
data were entered into EpiData software
the risk factors associated with HIV/HCV different serum samples and a confirmatory version 3.1 (EpiData Association, Odense,
coinfec- tion provides some indication of the test. The diagnosis of HCV infection was
Denmark) and ana- lyzed using the
ob- stacles faced by managers and health caredefined by seropositivity to anti-HCV test. InStatistical Product and Service Solutions
professionals in control and prevention of this context, the controls should be positive (SPSS) for Windows version 19 (IBM SPSS
these diseases. The current study aimed to for anti-HIV antibodies and negative for
Statistics, Chicago, Illinois, USA). Microsoft
contribute to these efforts by identify- ing riskHCV (anti-HCV negative). Pairing was
Office Excel 2007 (Microsoft Corporation,
factors associated with hepatitis C
performed by coupling one individual (case)Redmond, WA, USA) was used to achieve
seropositivity in people living with HIV. The of the same gender and age with two
age- and gender-matching manually. The
results from this research can be compared individuals (control) up to the limit of a
vari- ables were described as measures of
with similar data from other regions to help three-year age difference. Patients who
central tendency and dispersion in the case
direct preventive and edu- cational efforts signed the consent form were invited to
of continuous variables. Categori- cal
targeting people living with HIV.
participate in the study and were
variables were described as abso- lute
interviewed individually in a reserved room.numbers and proportions. The nonPatient identification was excluded from the parametric Wilcoxon (MannWhitney U)
MATERIALS AND METHODS
data collection tool, and the identities of the test was used in the case of variables with
subjects were kept confidential and
non-normal distribution. Crude and adjusted
The current research was a case-con- trol
anonymous.
The
data
collection
instrument
logistic regres- sion analyses were performed
study nested within a cross-sectional study
consisted
of
demographic
and
to test the independence of association
examining prevalent cases of HIV infection.
socioeconomic vari- ables (gender, age,
between the outcome (HIV/HCV
The authors surveyed HIV-in- fected
coinfection) and the explanatory variables
individuals treated at specialized outpatient ethnicity, education level, and household
clinics in three cities in Santa Catarina State income); sexual behavioral variables (age at and esti- mate the odds ratios (ORs) and
in Southern Brazil between October 2011 andfirst inter- course, sexual orientation, numberrespec- tive 95% CIs using Stata SE version
August 2012. Injecting drug use was taken of lifetime sexual partners, and sex without 9.0 (StataCorp LP, College Station, Texas,
USA). Variables that showed P < 0.20 in the
into ac- count to determine the sample size, using a condom); personal and lifestyle
behavior
variables
(tattooing,
sharing
chi-square test were included in the adjusted
con- sidering a prevalence of HCV infection
personal
items
such
as
toothbrushes,
razor
analysis in blocks, according to the following
in HIV-infected persons of 30% among cases
blades,
or
nail
clippers,
and
alcohol
order: socio-demographic data, sexual
(5) and 5.9% among controls (7), with a 95%
confidence interval (CI), for a power value ofconsumption); and morbidities and drug usebehavior, lifestyle behavior, morbidities, and
(history of blood transfusions, intravenous ordrug use (11), as shown in Figure 1.
80%. This resulted in 48 cases and 96
inhaled drugs such as cocaine and crack,
controls at a 1:2 ratio, with a minimum
FIGURE 1. Hierarchical model for selection of confounding variables associated
to medical
sample size of 144 subjects for the study. A exposure
with HIV/ hepatitis C virus coinfection among HIV-infected patients at outpatient
10% addition was made to the total sample
clinics in three cities in Santa Catarina State, Brazil, October 2011August 2012
to compensate for losses. OpenEpi software
st
1 LEVEL
version 2.3.1 (Open Source Epidemiologic
Demographic
Socioeconomic
Statistics for Public Health,
Gender
Education
characteristics
characteristics
Age Skin
Household
www.openepi.com) was used to calculate the
color
income
sample size. The study sample included
male and female patients aged 18 years and
2nd LEVEL
older with a laboratory diagnosis of HIV inSexual behavior
Lifestyle behavior
Morbidities and drug
fection who were treated at the out- patient
First sexual intercourse
Tattooing Sharing personal use
History of blood
clinics for at least four months and agreed to Sexual orientation Number hygiene objects Alcohol
transfusion Injecting
participate in the study by signing a consent
of lifetime sexual partners
consumption
drug use Cocaine use
Condom use during sex
Crack use
form. Individuals without serological tests
for hepatitis C and/or deemed unable to
OUTCOME
3participate
Type of white blood cells that are measured to as- sess
HIV progression.

54 Rev Panam Salud Publica 35(1), 2014

HIV/HCV
coinfection

The first block of the model in- cluded

TABLE
for socio-demographic
1. Crude/adjusted
variables,
odds ratios
sexual/a lifestyle behavior, morbidity, and drug
variables with P < 0.05. The second block (ORs)
use associated with HIV/hepatitis C virus coinfection among HIV-infected patients
included variables with
at outpatient clinics in three cities in Santa Catarina State, Brazil, October 2011
P < 0.20. Variables with P < 0.05 in this block
August 2012
were considered signifi- cant, and the
Variable Cases
Controls (%) (n = 110)
Adjusted OR
variables of the previ- ous block were
(%) (n = Crude OR (95% CI
b
(95% CI)
)P
55)
maintained, even with
P > 0.05. This procedure was repeated for Socio-demographic Skin color 0.060 White 74.5 86.4 1 1
the third, fourth, and fifth blocks. This study
was approved by the Re- search Ethics
Non-white 25.5 13.6 2.03 (0.934.46) 2.28 (0.955.46) Education (in years) 0.011
Committee of the Univer- sity of Southern 08 76.4 56.0 2.67 (1.205.92) 2.95 (1.217.19)
Santa Catarina (Santa Catarina State, Brazil)
9 23.6 44.0 1 1 Household income (R$
under registration number 11.060.4.01.III. ) 0.053 0.001 300 c00 62.7 46.3 1.96 (0.983.93) 1.40 (0.653.03) > 1 300 00 37.3
53.7 1 1 Sexual behavior First intercourse (age in years) 0.005

RESULTS
In total, 165 HIV-infected individu- als were
d
15 64.8 41.7 2.48 (1.235.03) 2.21 (1.024.79)
studied, of whom 55 were considered cases
> 15 35.2 58.3 1 1 Sexual orientation 0.045 Homosexual/bisexual 12.7 26.4 1.81
(HIV/HCV-coinfected) and 110 controls
(0.883.75) 2.76 (0.948.09)
d
(HIVmono-infected), paired by age and
Heterosexual 87.3 73.6 1 1 Number of lifetime sexual partners 0.122
gender. The mean age of the surveyed
subjects was 43.6 (standard deviation (SD) =
d
015 46.3 59.1 1 1.68 (0.664.24)
8.4) years, ranging from 19 to 64 years;
> 15 53.7 40.9 1.79 (0.823.89) Unprotected sex 0.115 Yes 69.1 56.4 1.81 (0.88
70.9% were male. The majority (79%) of re- 3.75) 2.47 (0.996.16)
d
spondents lived with relatives, 18% lived
No 30.9 43.6 1 1 Lifestyle behavior Tattooing 0.016 Yes 63.6 19.1 2.24 (1.074.68)
alone, and the remainder lived with friends
2.25 (1.014.97)
or in institutions. Household income and
e
the number of lifetime sexual partners
No 36.4 80.9 1 1 Sharing personal objects 0.658 Yes 47.3 43.6 1.11 (0.602.07) No
showed an asymmetric distribution. With 52.7 56.4 1 Morbidity Blood transfusion < 0.001 Yes 61.8 88.3 5.30 (2.0913.41)
regard to the comparison between medians,6.17 (2.0218.79)
it was found that cases had lower
household income (P = 0.011) and a higher
f
num- ber of sexual partners (P = 0.047) than
No 38.2 11.8 1 1 Drug use Injecting-drug < 0.001 Yes 56.4 3.6 41.6 (5.59308.67)
controls. Table 1 shows the distribution of 21.32 (2.00226.68)
variables between the groups and the
g
results of univariate and multivariate
No 43.6 96.4 1 1 Cocaine < 0.001 Yes 67.3 25.5 7.13 (2.9317.33) 2.25 (0.647.85)
analysis.
g

Univariate analysis of factors

associated with HIV/HCV coinfection

No 32.7 74.5 1 1 Crack < 0.001 Yes 41.8 13.6 5.60 (2.2414.03) 1.57 (0.337.34)
g

No 58.2 86.4 1 1 Alcohol 0.721 Yes 70.9 68.2 1.1 (0.62.3) No 29.1 31.8 1

Education level showed a statistically

significant difference (P = 0.011) in the
comparison between groups. There was a a
Conditional logistic analysis, paired by sex
band
predominance of poor education in both
CI: 95%
age. confidence
c R$: Brazilian
groups, but cases had a higher percentage ofdinterval.
Adjusted
OR values for education
reals.
individuals with eight years of schooling or elevel.
Adjusted OR values for education level and first sexual
f intercourse.
Adjusted OR values for education level, first sexual intercourse,
less. Cases had a higher percentage of non- gand
Adjusted
OR values for education level, first sexual intercourse, tattooing,
tattooing.
whites in the sample composition and lower and blood transfusion.
in- come, but without statistical significance
(P = 0.060). With respect to personal
(P = 0.016); and intravenous (P < 0.001) and Transfusion of blood and blood combehavioral aspects, early first sexual
intercourse (P = 0.005); sexual orientation inhaled (P < 0.001) drugs were considered ponents showed statistical significance in the
(being gay, lesbian, or bisexual) (P = 0.045); risk factors for HIV/HCV coinfection in theunivariate analysis (P < 0.001). Of the 34
crude analysis.
patients with a history of blood
tattooing

Rev Panam Salud Publica 35(1), 2014 55

transfusion, 11 (32.4%) had their first

frequency of multiple lifetime sexual
DISCUSSION Demographic and
transfusion prior to 1992. In this study, risk socioeconomic
partners and unprotected sexual interfactors associated with exposure to medical
course also prevailed among HIV/HCV
procedures such as contaminated sharps (P characteristics
coinfection cases, but without statisti- cal
= 0.081), injections done by unlicensed
significance. Sexual transmission is the main
The mean age of participants in this study
persons (P = 0.300), previous surgery (P =
mode of HIV transmission (7, 19). Sexual
was similar to that observed in a study
0.330), and endoscopy (P = 0.650) did not aptransmission as a route for HCV infection is
conducted in So Paulo to es- timate the
pear to be risk factors for HIV/HCV
not well defined yet. Nonetheless, data
prevalence of HIV, hepatitis B and C, and
coinfection.
reported over the last decades, mainly in
syphilis among homeless people (12). The
Europe, have shown that HCV infection is
age group most affected by AIDS in Brazil is
Multivariate analysis of factors
implicated in this mode of transmission
that of young adults (7). The higher AIDS
associated with HIV/HCV
among men who have sex with HIV-infected
prevalence in this age group is assumed to
coinfection
men (20). A study conducted at Mount Sibe related to the fact that young adults are
nai Hospital (New York, USA) between 2005
Variables associated with HIV/HCV
more exposed to HIV risk factors such as
coinfection in the univariate analysis were unprotected sex with multiple partners and and 2010 assessed a cohort of 74 HIVinfected men who have sex with men (MSM)
included in the multivariate analy- sis in
drug use. There was a predominance of male
with no report of injecting drugs. The
blocks. In the first block, the skin color,
participants in the current study, con- sistent
results showed that this high-risk sexual
education level, and household income
with national and international data
variables were included, but only education indicating that men are the most severely behavior was the most likely mode of HCV
transmission in the group (21). In the
level appeared to be an independent factor. affected by HIV, HCV, and, consequently,
Low-educated individuals were more likely coinfection with both dis- eases (6, 7, 1315). current study, being less than 15 years old at
first intercourse appeared to be a risk factor,
to be HCV- coinfected (OR = 2.95; 95% CI: However, age and gender were not
1.217.19). In the second block, adjusted for associated with coin- fection in this study with twice the chance of HIV/HCV
coinfection among those with this history.
edu- cation level, the variables age at first due to the pairing process. The higher
These findings can be explained by the fact
sexual intercourse, sexual orientation,
prevalence of HIV infection, HCV infection,
that in their quest for autonomy adolescents
number of sexual partners, and unand HIV/HCV coinfection among men in
tend to ex- perience sex at an early age, as
protected sex were included. Age at first
Brazil appears to be due to their sexual
well as condom misuse, alcohol
sexual intercourse < 15 years old was
practices and drug abuse. In 1985, the case
revealed to be a risk factor, and patients withproportion for HIV infection was 26 men for consumption, and drug abuse (22), making
them vul- nerable to sexually transmitted
this characteristic were more likely to be
each woman, but by 2010 it had decreased to
coinfected compared to their counterparts 1.7:1 (7). Although the gender ratio has been diseases (STDs) such as HIV and hepatitis C.
Lifestyle behavior and morbidity
(OR = 2.21; 95% CI: 1.024.79). In the third decreasing over time, men are still more
block, adjusted for ed- ucation level and age affected by HIV and HCV infec- tions than
Tattooing was also a risk factor as- sociated
at first sexual intercourse, the variable
women (5, 7). The proportion of injecting
with coinfection. A study of blood samples
tattooing was included, which appeared to drug users is also higher in men than in
from patients with HIV infection conducted
be an in- dependent factor, with greater
women (16). In the current study,
in the city of Ma- cei (Alagoas, Brazil) in
chance for coinfection among tattooed
educational at- tainment was an independent2005 concluded that tattooed individuals
people compared to people without tattoos factor for HIV/HCV coinfection. This
were five times more likely to have HCV
(OR = 2.25; 95% CI: 1.014.97). In the fourth finding is consistent with studies conducted
infection (23). This finding can be explained
block, adjusted for significant variables in in 2003 and 2005 with patients living with
by the fact that the needles used for
the first three blocks, the blood transfusion HIV in So Paulo (16, 17). Patients in the
tattooing may not be properly sterilized or
variable was included. This variable was a current study were attended by the Brazilian
sanitized and the inks and pigments may not
risk factor, with those reporting a previ- ousPublic National Health System (Sistema
be maintained in a sterile packaging and can
blood transfusion having a greater chance nico de Sade, SUS), which serves
therefore serve as a route for HIV
for coinfection than those who had never predominantly poor people with limited
transmission (24). History of blood
received a transfusion of blood or blood
education (18), so education level may have transfusion appeared to be a risk factor, with
exposure behavior associated
products (OR = 6.17; 95% CI: 2.0218.79). Sexual
influenced the results.
those reporting this characteristic having a
with
HIV/HCV
coinfection
The fifth block included the variables related
five times greater chance of HIV/HCV
to drug use, adjusted for the previous levels.
Homosexual and bisexual individu- als,
coinfec- tion. This finding is in accordance
HCV-coinfected peo- ple were more likely to
who tend to have anal sex more frequently with data from Pavan et al. (25), who found
be injecting drug users (OR = 21.32; 95% CI:
than heterosexuals, showed the highest
that 14.6% of transfused patients were
2.00 226.68).
percentage of HIV/HCV coinfection among infected with HIV, hepatitis B and C, and
controls. A higher
syphilis. Monteiro et al. (26) found that

56 Rev Panam Salud Publica 35(1), 2014

blood transfusion corresponded to a 4.7

Among individuals who reported injecting care services considered patients with
times greater chance for HCV infection
drug use, 85.7% were in the group of
reactive results to anti-HCV to be coinamong HIV-infected patients. With the
HIV/HCV cases, also consid- ered an
fected. Of the 55 cases of coinfection, 25
chance of HCV infection among blood
independent risk factor for coin- fection,
(45.5%) had viral presence confirma- tion by
transfusion cases 16 times higher com- paredresulting in a 21.32 times greater chance of qualitative HCV-RNA, and five (9.1%) had
to controls, history of blood trans- fusion
exposure among the HIV/ HCV-coinfected chronic hepatitis detected by liver biopsy. It
appeared to be an independent risk factor forpatients, after adjusting for confounding
was difficult to access the confirming data
HIV/HCV coinfection. Among the
variables. A similar re- sult was observed in abecause the patients (all of whom were all
participants who reported previous blood study conducted in So Paulo with injecting aware of their coinfection) were from
transfusion, 32.4% per- formed the first
drug users infected with HIV and receiving different cities, some were under treatment
transfusion prior to 1992, a period in which treat- ment at a municipal STD/AIDS health in other medical centers, and the available
there was no screening for HCV infection in department that showed a percentage of
infor- mation often had data gaps and
blood bags and blood products. In this study,82.4% of HIV/HCV coinfection (16). In a
quality issues. However, seropositivity to
there was no statistically significant
case-control study comparing HIV- infected the anti-HCV test has been used in several
difference between controls and cases with individuals with HCV coinfec- tion, Wolff et other studies (4, 6, 13, 28, 29) to define
respect to the use of shared objects for
al. (11) found that injecting drug users were HIV/HCV coinfection and was thus
personal hygiene, so that variable was not an21.6 times more likely to have HCV infectionconsidered a valid means of determin- ing
independent risk factor for coinfection, even compared to HIV mono-infected subjects. Incoinfection rates.
Conclusion
though the literature cites the sharing of ob- the United States and Europe, injecting drug
jects as means of person-to-person HCV
users infected with HIV showed a 50% and
The results from this study showed that the
transmission (27).
90% prevalence rate of HCV coinfection
independent factors associated with
Drug use associated with HIV/HCV respectively (34, 35). In a study conducted in HIV/HCV coinfection were poor
Switzerland, the percentage of HCV infection
coinfection
education, early first sexual intercourse,
in pa- tients with HIV was 30 times higher in
tattooing, previous blood transfusion, and
Inhaled cocaine and crack users showed
injecting drug users compared with those
intravenous drug use. Based on the
higher rates of coinfection com- pared to HIVwho reported no use of illicit injecting drugs
findings from this study, the authors
mono-infected subjects. These results are
(36). This high transmis- sibility can be
suggest that health infor- mation about the
consistent with other studies in which
explained by the shared use of needle and
risk factors for HCV infection be provided
sharing the inhalation implements of cocainesyringes, facilitating blood-to-blood
on an ongoing basis, especially among
and crack poses a risk for HCV coinfection intransmission (37). Inject- ing drug use is a
HIV-infected patients, to prevent
HIV-infected individuals (28, 29). Snorting major route of HIV and HCV transmission
coinfection. Preven- tive education against
and sniff- ing drug equipment easily damage(38).
drug abuse along with effective measures
Limitations
nose lining to cause bleeding, thus facilitating
to improve health and quality of life are of
HIV/HCV transmission (30). Drug use may
utmost importance.
Limitations
of
this
study
were
1)
the
also predispose those with that behavior to
Acknowledgments. The authors thank the
exclusion
of
some
individuals
with
inother risky behaviors such as promiscuity,
teams of the Centro de Aten- dimento
complete
medical
records;
2)
the
lack
of
data
lack of condom use, and homosexual
Especializado em Sade (CAES),
intercourse, among others (30). In addition, on anti-HCV results in the medical records; Vigilncia Epidemiolgica de Tubaro, Polisex can be a means to get more drugs (31). and 3) the exclusion of pa- tients with
clnica Municipal de Imbituba, and Unidade
negative serology for anti- HCV who had old
However, the re- sults of this study, after
Sanitria Central de Capivari de Baixo for
serological records (to avoid including
adjustment for confounding variables,
allowing this study to be performed. They
indicated use of inhaled drugs was not an patients who had become coinfected since also thank the Support Program for Post
their last test). In addition, the inclusion of
independent factor associated with
Graduate Private Teaching Institu- tions
coinfection. The data revealed that alcohol patients with positive serology for anti-HCV(Programa de Suporte Ps-Gradua- o de
abuse was not a risk factor for HIV/HCV may have resulted in an overestimation of Instituies de Ensino Particulares, PROSUP) of
the coinfection percentage caused by
coin- fection even though it predisposes those
the Coordination for the Improvement of
possible false-positive results, as the antiwith that behavior to unsafe sexual pracHigher Education Per- sonnel (Coordenao de
tices. Studies have shown that moderate to HCV test does not define active HCV
Aperfeioamento de Pessoal de Nvel Superior,
severe consumption of alcohol is as- sociatedinfection, a status that requires molecular CAPES) Pro- gram of the Brazilian Ministry
with the practice of unprotected sex, multiplebiology tests such as HCV- RNA for
of Educa- tion for financial support.
partners, casual sex, sexual intercourse with confirmatory diagnosis. As those results
Conflicts of interest. None.
were not always avail- able in patient
sex workers, and drug use (32, 33).
medical records, health

Rev Panam Salud Publica 35(1), 2014 57

Original research Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV

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Hepatitis C virus seroprevalence and risk facrisco entre portadores do VIH/

58 Rev Panam Salud Publica 35(1), 2014

Kuehlkamp et al. Factors associated with hepatitis C seropositivity in people living with HIV Original research

Objetivo. Determinar los factores de riesgo asociados con la seropositividad al virus de

la hepatitis C (VHC) en pacientes infectados por el virus de la inmunodeficiencia
humana (VIH)
Factores asociados con la Mtodos. Se llev a cabo un estudio de casos y testigos apareados, ajustados por edad y
seropositividad al virus de la sexo. Este estudio, realizado mediante muestreo no probabilstico, incluy a adultos
coinfectados por el VIH y el VHC (casos) y a otros infectados nicamente por el VIH
hepatitis C en personas con (testigos). Se recopilaron datos mediante entrevistas y revisiones de ex- pedientes
mdicos. Se utiliz la prueba de ji al cuadrado para comparar las variables categricas, y
infeccin por el VIH
la prueba t de Student o la prueba de Wilcoxon (U de MannWhitney) para las variables
continuas. Se calcularon los intervalos de confianza (95%) junto con las razones de
posibilidades brutas y ajustadas mediante el empleo de un modelo de regresin logstica
Resultados. Fueron estudiados 165 pacientes (55 casos y 110 testigos). La media de edad
condicional.
fue de 43,6 8,4 aos, con edades comprendidas entre los 19 y los 64 aos; 70,9% eran
hombres. Los factores de riesgo independientes de coinfeccin por el VIH y el VHC
fueron la educacin (hasta ocho aos de escolarizacin); la primera relacin sexual a una
edad inferior a los 15 aos; los tatuajes; la transfusin de sangre; y el consumo de drogas
inyectables.
Conclusiones. El escaso nivel de formacin, la primera relacin sexual a una edad
temprana, los tatuajes, las transfusiones de sangre y el compartir agujas y otros mate- riales
de inyeccin de drogas fueron factores que aumentaron el riesgo de coinfeccin por el VIH y
el VHC. Se pueden comparar los resultados de esta investigacin con datos similares de
otras regiones para orientar las iniciativas preventivas y educativas dirigidas a las personas
infectadas por el VIH.
Factores de riesgo; hepatitis C; VIH; coinfeccin; estudios de casos y controles, Brasil.
Palabras clave
resumen

Rev Panam Salud Publica 35(1), 2014 59