Sickle cell disease is associated with decreased HIV but higher HBV and HCV comorbidities in U.S. hospital discharge records: a cross-sectional study

Abstract

Objective: Some studies suggest that HIV infection progresses slowly in patients with sickle cell disease (SCD). The authors aimed to determine the relationships between SCD and HIV infection.

Methods: National Hospital Discharge Survey data from adult African-Americans in the period of 1997-2009 were analysed. The comorbidities of SCD with HIV infections in hospital discharges were analysed. Multiple logistic regression was used to test the association between SCD and HIV. For comparative purposes, the relationships of SCD with hepatitis B virus (HBV) and hepatitis C virus (HCV) were also assessed.

Results: 423,431 records were divided into two time periods 1997-2003 (53% of records) and 2004-2009 (47% of records). The frequency of HIV diagnosis was lower in patients with SCD (1.5% vs 3.3% in patients without SCD). In logistic regression, SCD diagnosis was associated with an OR of 0.24 (95% CI 0.18 to 0.32) for HIV diagnosis in the first period and with an OR of 0.31 (95% CI 0.22 to 0.42) in the second period. In contrast, SCD was associated with higher risk of HCV (OR=2.01, 95% CI 1.56 to 2.59 in the first period and OR=2.12, 95% CI 1.71 to 2.63 in the second period). SCD was also associated with a higher risk of HBV (OR=1.15, 95% CI 0.72 to 1.83 in the first period and OR=1.82, 95% CI 1.24 to 2.68 in the second period).

Conclusions: The lower risk of HIV comorbidity, but not HCV and HBV, with SCD is consistent with the possibility that SCD has a unique effect in altering the risk of HIV infection or progression. Investigation of how the haemolytic and immunological changes of SCD influence HIV might lead to new therapeutic or preventive approaches.

Figure 1

The frequency of different diagnoses in hospital discharges. Bars indicate the CI of frequencies calculated from Poisson distribution.

Figure 2

(A) Frequency of sickle cell disease (SCD) diagnosis by age group and gender. Denominator for each frequency is total number of hospital discharges for the same age group and gender. (B) Frequency of HIV diagnosis by age group and gender. Denominator for each frequency is total number of hospital discharges for the same age group and gender. (C) Frequency of HIV diagnosis by age group and sickle cell diagnosis. Denominator for each frequency is total number of hospital discharges for the same age group and sickle cell status.