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BACKGROUND: A number of studies show that people with HIV infection are often infected with viral hepatitis. Hepatitis has become one of the leading causes of non-AIDS-related deaths in this population. In the United States, approximately 25% of HIV positive individuals are co-infected with hepatitis C virus (HCV). The Pennsylvania (PA) Department of Health’s electronic reportable disease surveillance system (PA-NEDSS) is a patient-centric system which includes data on many disease conditions, including HIV and HCV. A common patient identifier links these conditions together, and provides an opportunity to examine their combined impact.
METHODS: PA-NEDSS was queried to identify HIV cases in Pennsylvania (excluding Philadelphia) from 2003 – 2012. Cases co-infected with HCV were identified by matching patient identifiers to patient identifiers of HCV cases. The records were analyzed to develop crude proportions by sex, age, race, transmission category and vital status. Contingency tables were used to describe the characteristics.
RESULTS: Of 8,316 individuals diagnosed with HIV infection between 2003 and 2012, a total of 729 (8.8%) cases were co-infected with HCV. Overall co-infection rate was 9.8% in females and 8.4% in males. Co-infected cases were older than monoinfected cases, with 41.8% of the co-infected cohort aged 40-49 years and 28.3% > age 50; in the monoinfected cohort, 30.0% were 40-49 and 18.8% were > 50. Co-infection rates increased with age, ranging from 0% in those < 13 years old to 12.6% in those > 50. By race, Hispanics had the highest co-infection rate at 13.1%, followed by non-Hispanics persons of mixed race (12.0%), non-Hispanic blacks (8.0%), and non-Hispanic whites (7.5%). By transmission category, HIV cases for whom intravenous drug use (IDU) was the only risk factor had a co-infection rate of 31.4%, whereas men who have sex with men (MSM) and who were not IDU had a co-infection rate of 2.9%. Death was reported among 18.0% of co-infected cohort compared to 11.1% of HIV monoinfected cohort (p< 0.0001).
CONCLUSIONS: There was increasing rate of HCV co-infection with increasing age. HIV and HCV co-infection may be related to disparities which are prevalent among certain age and racial groups and with specific risk factors such as IDU. This emphasizes the need for: 1) integrated HCV and HIV prevention activities at the federal, state and local levels, 2) periodic HCV testing for individuals diagnosed with HIV infection, and 3) education of HIV and HCV patients on the importance of safe sex and needle exchange.