Hepatitis C and HIV in Northern BC: Current trends

An update on HIV in the North would not be complete without a review of basic statistics related to both hepatitis C and HIV.

In the figures below we make reference to the previous 10 years for both hepatitis C and HIV. The reason that we include hepatitis C in an update on HIV is that hepatitis C is contracted through blood, as is HIV. One of the key risk factors for contracting hepatitis C (intravenous drug use) is also a risk factor to contracting HIV; however, hepatitis C is more infectious than HIV.

If a person was engaging in the high-risk behaviour or practice of using intravenous drugs and sharing equipment to mix or inject the drugs they would be likely to become infected with hepatitis C before HIV. In this situation, hepatitis C may be viewed as a precursor to HIV if the related risk factor of sharing drug paraphernalia continued to exist.

Source: BCCDC COGNOS Application November 2011

It can be seen that although there are variations from year to year, generally the incidence of hepatitis C is going down in each area and in Northern Health overall. There were 137 new cases in 2010 compared to 278 in 2001. This downward trend is similar to the provincial trend. Of the 137 new cases of hepatitis C in Northern BC, approximately 40 per cent are female and 60 per cent are male.

Source: BCCDC COGNOS Application November 2011

This diagram shows the age distribution of new cases of hepatitis C in Northern BC. The bar graph shows that most often people are in their 40s and 50s when they are newly identified with hepatitis C in Northern BC. However, four people were between 15 and 24 years of age and 21 people were between 25 and 34 years of age when they were identified with hepatitis C in 2010.

In keeping with the above comment about hepatitis C being seen as a precursor to HIV, it should be noted that these 25 young people may be at risk for contracting HIV due to their high-risk behaviours.

Source: BCCDC COGNOS Application November 2011

During 2010 in Northern BC, there were 16 newly diagnosed cases of HIV. This is a decrease from the six previous years when cases totaled in the mid-to-high 20s. This number includes those people who had their HIV tests taken in Northern BC and were identified HIV-positive as a result of those tests.

Source: BCCDC COGNOS Application November 2011

Over the past several years Aboriginal people have been overly represented among those who are newly diagnosed with HIV.  This chart shows that in 2010 approximately 40 per cent of people newly diagnosed with HIV identified themselves to be of Aboriginal heritage.

This is a decrease from previous years, as in 2007, 68 per cent of people newly diagnosed with HIV identified themselves as being of Aboriginal heritage. The 40 per cent for 2010, though a decrease from previous years, still reflects over-representation of Aboriginal people, as they make up about 20 per cent of the population in Northern Health.

Data related to ethnicity depends on the tester asking the person being tested about ethnicity. In 2010 data, approximately 20 per cent of people newly diagnosed with HIV did not report ethnicity.

In Northern BC, 62 per cent of people newly diagnosed with HIV in 2010 were between the ages of 40 and 59 years, and 70 per cent of people newly diagnosed with HIV were male.

When people are tested for HIV they are asked about risk factors related to HIV. In Northern BC, the risk factor most frequently reported by those testing positive for HIV has been intravenous drug (50 per cent, or eight of 16) with 31 per cent (five of 16) identifying their risk factor as heterosexual contact. The reports of those with other risk factors in 2010, such as street workers and men who have sex with men, were minimal.

While it appears that the overall incidence of HIV in the North decreased in 2010, the current data for 2011 indicate an increase. As of mid-November 2011, there were 21 cases of newly-diagnosed HIV in the North.

In order to diagnose HIV early and improve access to care, testing for HIV is paramount. Early identification of HIV promotes behaviour change at a time when the person with HIV is most infectious and early access to treatment contributes to decreased viral load and potentially decreased transmission of HIV.

Testing for HIV has been reliant on targeting people with known risk factors to HIV. The exception to this is for women during pregnancy. An HIV test is routinely offered to women in the prenatal period. As a result of this practice, women are tested for HIV more than twice as often as men. As can be seen above, the overall numbers of HIV tests per year have been fairly stable over the last several years.

Considering that in Northern BC the majority of newly identified cases of HIV are discovered in mid-life, one wonders if HIV may have been contracted at a younger age. A broader testing strategy could contribute to early diagnosis, better access to care and prevention of the spread of the infection.

The table above shows that the majority of HIV tests in the Northern Health area are either ordered while people are in hospital or at their physicians’ offices. A good proportion of HIV tests in physicians’ offices are most likely related to prenatal testing.

New guidelines for HIV testing suggest that all people who are or have been sexually active should be tested for HIV. As the general public are for the most part connected to general practitioner physicians, there is opportunity to advocate for increased HIV testing among physicians in addition to encouraging the public to seek HIV tests on their own.