Epidemiology of the Viral Hepatitis-HIV Syndemic in San Francisco: A Collaborative Surveillance Approach

Abstract

Objectives. To describe the epidemiology of people coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV in San Francisco, the San Francisco Department of Public Health's Communicable Disease Control and Prevention Section and the HIV Epidemiology Section collaborated to link their registries .Methods. In San Francisco, hepatitis reporting is primarily through passive laboratory-based surveillance, and HIV/AIDS reporting is primarily through laboratory-initiated active surveillance . We conducted the registry linkage in 2010 using a sequential algorithm.Results. The registry match included 31,997 HBV-infected people who were reported starting in 1984; 10,121 HCV-infected people who were reported starting in 2001; and 34,551 HIV/AIDS cases reported beginning in 1981 . Of the HBV and HCV cases, 6 .3% and 12 .6% were coinfected with HIV, respectively . The majority of cases were white males; however, black people were disproportionately affected . For more than 90% of the HBV/HIV cases, maleto-male sexual contact (men who have sex with men [MSM]) was the risk factor for HIV infection. Injection drug use was the most frequent risk factor for HIV infection among the HCV/HIV cases; however, 35 .6% of the HCV/HIV coinfected males were MSM but not injection drug users .Conclusions. By linking the two registries, we found new ways to foster collaborative work and expand our programmatic flexibility . This analysis identified particular populations at risk for coinfection, which can be used by viral hepatitis and HIV screening, prevention, and treatment programs to integrate, enhance, target, and prioritize prevention services and clinical care within the community to maximize health outcomes .

HIV and viral hepatitis co-infection in New York City, 2000–2010: prevalence and case characteristics

“…This is consistent with other studies that have found that male sex, black race, and Hispanic ethnicity are associated with higher risk of HIV co-infection with HBV and HCV [10, 12, 17]. The HIV transmission risk categories of individuals at highest risk for HIV co-infection with HBV or HCV in NYC were also consistent with the transmission routes of and reported risk factors for HBV and HCV [10, 11, 13–16, 18]. The largest proportion of HIV/HBV-infected individuals were MSM, while the largest proportion of HIV/HCV-infected and HIV/HBV/HCV-infected individuals had a history of IDU.…”

“…Multiple clinical cohort and cross-sectional studies have studied the prevalence of and risk factors for HBV and HCV co-infection in groups of people living with HIV/AIDS (PLWHA) throughout the world [7,[10][11][12][13][14]. Another important method for assessing the prevalence of HIV co-infection with HBV and/or HCV and the characteristics of co-infected patients is to match surveillance data for each infection collected by state or local health departments [15][16][17][18]. Surveillance data are derived from large, geographically well-defined populations and include all positive tests reported to health departments; therefore, such data are more representative than data from highly specialized clinical studies, which are limited to patients selected for enrolment.…”

HIV and viral hepatitis coinfection analysis using surveillance data from 15 US states and two cities

“…The demography of the cohort of coinfected persons in our study matched that of other US studies regarding race and sex [23–27]. HIV transmission categories were correlated with the most common viral hepatitis transmission risks in the USA (sexual transmission for HBV and IDU for HCV) [3, 31, 32].…”

The prevalence of HIV co-infection among patients newly diagnosed with chronic hepatitis B or C in Denmark – a nationwide cohort study

“…The prevalence of HIV coinfection among CHB patients found in our study is slightly lower than the estimates published from other low HIV-prevalence settings (United States) of 5.2%–6.3% among CHB patients [26, 27], whereas the overall HIV coinfection prevalence of 5.3% among CHC patients found in our study was similar to estimates found in larger CHC patient cohorts from the United Kingdom (UK) and the United States at 5.0% and 4.3%, respectively [27, 28].…”