BACKGROUND: The Medical Monitoring Project (MMP) is a federal surveillance project designed to produce nationally representative data on people living with HIV/AIDS (PLWH). MMP has two components: an interview and medical record abstraction. This analysis describes demographic characteristics, risk behaviors, need for supportive care and HIV viral suppression among PLWH who are co-infected with hepatitis C and in care using Washington State MMP interview and medical record data.
METHODS: MMP data from years 2009-2014 were used for this analysis. Patient interviews were used to describe patient demographics, use of medical and social services and risk behaviors and medical records were used to describe HIV viral suppression. For the analysis, an individual was considered to be co-infected with HIV and hepatitis C if he/she had evidence of ever having a positive hepatitis C test in the medical chart, and did not have a subsequent documented negative test result.
RESULTS: In 2009-2014, 15% of HIV-positive persons in care in Washington were co-infected with hepatitis C, and this proportion did not differ significantly by year. Relative to the HIV mono-infected group, HIV/hepatitis C co-infected persons were significantly older (p=0.010), less educated (p<0.0001), had less income (p<0.0001), more likely to be heterosexual (p<0.0001), had higher percentages of individuals incarcerated in the prior 12 months (p<0.0001) and homeless in the prior 12 months (p<0.0001). Approximately 21% of this group reported injection drug use in the past year and 59% were current smokers at time of interview. Co-infected persons had significantly higher unmet needs for supportive care services (p=0.0005), with 65% of individuals reporting at least one unmet need. The services for which there was the most unmet need among co-infected persons included dental (32%), vision (27%), nutrition (14%), peer group support (12%), transportation (11%), legal (11%), mental health (10%), and drug and alcohol services (8.5%). Co-infected persons had comparable and high rates of HIV antiretroviral (ARV) drug use and HIV viral suppression. 91% of the co-infected persons were on ARVs and 83% were virally suppressed (<=200 copies per ml).
CONCLUSIONS: HIV-positive persons in care in Washington from 2009 through 2014 who were co-infected with hepatitis C experienced significantly more socioeconomic challenges and unmet care needs than persons who were only infected with HIV. Despite these obstacles, co-infected persons had comparable rates of ARV use and HIV viral suppression. Care providers should not wait for situational factors to be addressed before treating HIV viral load.