Using Cross- Matched Surveillance Data to Describe Persons With HIV-Hepatitis C (HCV) Co-Infection and Persons With HIV-Hepatitis B (HBV) Co-Infection in New York City, 2000-2010

BACKGROUND:  In 2010, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented CDC’s Program Collaboration and Service Integration (PCSI) initiative to increase data sharing across infectious disease surveillance programs.  HIV and viral hepatitis co-infection is particularly important to understand, as co-infected individuals experience increased morbidity and mortality, including accelerated progression to advanced liver disease.

METHODS:  We conducted a cross-match of the NYC DOHMH  HIV, STD, TB, chronic hepatitis B, and chronic hepatitis C registries for the period January 1, 2000 through December 31, 2010, and the NYC death registry from 2000-2011. Persons alive and reported to the DOHMH as of 2000 and persons diagnosed and reported between 2000 and 2010 were included in the dataset. We analyzed the demographic and geographic distribution of HCV and HBV co-infection among persons living with HIV/AIDS (PLWHA)   in NYC between 2000 and 2010. Analyses were conducted using SAS 9.2; maps were created using ArcGIS version 10.

RESULTS:  Of 140,685 PLWHA in the final matched dataset, 16.4% (N=23,101) were co-infected with HCV.  Compared to PLWHA not co-infected with HCV, PLWHA co-infected with HCV were more likely to be Hispanic (42% vs. 31%), be over 40 years (47% vs. 34%), have a history of injection drug use (60% vs. 16%), and have a history of incarceration (31% vs. 11%) (p<0.05 for all comparisons). Over 70% of both groups were male. Of the 140,685 PLWHA in the final matched dataset, 5.8% (N= 8,191) were co-infected with HBV. PLWHA co-infected with HBV were more likely to be black (55% vs. 45%) and to be  men who have sex with men (MSM) (32% vs 30%) than PLWHA not co-infected with HBV (p <0.05 for all comparisons).

CONCLUSIONS:  Matching disease surveillance data is important to better understand the local epidemiology of co-infection. These findings are a measure of the burden of HIV and viral hepatitis co-infection in NYC, which has not been previously described at the population level. PLWHA co-infected with HCV and HBV are different demographically; these data can be used by health departments to work with providers serving high morbidity neighborhoods and to target prevention messages, testing and care to the populations at highest risk for co-infection.