HCV prevalence can predict HIV epidemic potential among people who inject drugs: mathematical modeling analysis
Background
Hepatitis C virus (HCV) and HIV are both transmitted through percutaneous exposures among people who inject drugs (PWID). Ecological analyses on global epidemiological data have identified a positive association between HCV and HIV prevalence among PWID. Our objective was to demonstrate how HCV prevalence can be used to predict HIV epidemic potential among PWID.
Methods
Two population-level models were constructed to simulate the evolution of HCV and HIV epidemics among PWID. The models described HCV and HIV parenteral transmission, and were solved both deterministically and stochastically.
Results
The modeling results provided a good fit to the epidemiological data describing the ecological HCV and HIV association among PWID. HCV was estimated to be eight times more transmissible per shared injection than HIV. A threshold HCV prevalence of 29.0% (95% uncertainty interval (UI): 20.7-39.8) and 46.5% (95% UI: 37.6-56.6) were identified for a sustainable HIV epidemic (HIV prevalence >1%) and concentrated HIV epidemic (HIV prevalence >5%), respectively. The association between HCV and HIV was further described with six dynamical regimes depicting the overlapping epidemiology of the two infections, and was quantified using defined and estimated measures of association. Modeling predictions across a wide range of HCV prevalence indicated overall acceptable precision in predicting HIV prevalence at endemic equilibrium. Modeling predictions were found to be robust with respect to stochasticity and behavioral and biological parameter uncertainty. In an illustrative application of the methodology, the modeling predictions of endemic HIV prevalence in Iran agreed with the scale and time course of the HIV epidemic in this country.
Conclusions
Our results show that HCV prevalence can be used as a proxy biomarker of HIV epidemic potential among PWID, and that the scale and evolution of HIV epidemic expansion can be predicted with sufficient precision to inform HIV policy, programming, and resource allocation.
Other Information
Published in: BMC Public Health
License: https://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1186/s12889-016-3887-y
Funding
Qatar National Research Fund (NPRP9-040-3-008), Characterizing the HIV/AIDS epidemics in the Middle East and North Africa: Systematic reviews and quantitative assessments.
History
Language
- English
Publisher
Springer NaturePublication Year
- 2016
License statement
This Item is licensed under the Creative Commons Attribution 4.0 International License.Institution affiliated with
- Weill Cornell Medical College in Qatar (2001-2015)
- Hamad Bin Khalifa University
- College of Health and Life Sciences - HBKU