Grant: Travel Awards - Institute Community Support

Hepatitis C virus (HCV), hepatitis B virus (HBV) or HIV infections are associated with deaths globally, and in North America. The presence of multiple infections together (HCV, HBV and/or HIV) could be associated with more illness and deaths; however, information on impact of multiple infections is limited. We evaluated the effect of HCV, HBV and HIV infections on deaths from all causes in British Columbia, Canada. We analyzed the British Columbia Hepatitis Testers Cohort which includes approximately 1.7 million individuals tested for HCV or HIV, or reported as a case of HCV, HIV, or HBV from 1990 to 2015, and linked to administrative healthcare databases. We calculated death rates for people with HCV, HBV or HIV single, double, and triple infections. Using a statistical method (Cox proportional hazards regression), we analyzed factors associated with deaths from all causes among people tested for HCV, HBV and HIV infections. Out of 659,541 individuals that were tested, there were 34,641 (5.25%) deaths. The highest all-cause death rate was noted in individuals with HCV/HBV/HIV triple infection followed by HCV/HIV, HCV/HBV, and HBV/HIV double infections, and HCV, HIV and HBV single infections. Individuals with HCV/HBV/HIV triple infection had highest risk of death followed by HCV/HIV, HCV/HBV, HBV/HIV double infections, and HCV, HIV, and HBV single infections. Other factors associated with higher all-cause deaths included being male, comorbidities, problematic alcohol use, material deprivation, tuberculosis, diabetes, chronic kidney disease, heart failure and hypertension. Presence of multiple infections are associated with higher number of deaths with risk of dying highest among those with triple infections. Problematic alcohol use, comorbidities and material disadvantage were significantly associated with deaths from all causes. Interventions aimed at prevention and treatment of multiple infections and other comorbidities could significantly reduce deaths.