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HCV and HIV Co-Infection among Adolescents and Young Adults in Massachusetts: Implications for Prevention
1. HCV and HIV Co-Infection
among Adolescents and Young
Adults in Massachusetts:
Implications for Prevention
Daniel Church, Shauna Onofrey, Betsey
John, Kerri Barton, Alfred DeMaria
Massachusetts Department of Public Health
August, 2011
2. Goals of Presentation
Review information on recent increase of
hepatitis C virus (HCV) infection among young
injection drug users (IDU) in Massachusetts
Discuss a registry match with HCV and HIV
surveillance data for adolescents and young
adults
Discuss the prevention implications these data
have on HIV and viral hepatitis prevention
programs
3. HCV Surveillance in Massachusetts - 1
Hepatitis C has been a reportable disease in
Massachusetts since 1992
Reportable both as acute disease and HCV infection
(mostly chronic)
Case classification according to CDC Guidelines (2005)
Provider-based reporting system, working with local
health departments on acute case investigations
No direct funding to support viral hepatitis surveillance
4. HCV Surveillance in Massachusetts - 2
Viral hepatitis surveillance in Massachusetts is conducted
using web-based system (MAVEN)
5. Reported Cases of HCV Infection in
Massachusetts: 2000-2010
Confirmed Probable
7000
6000
5000
4000
3000
2000
1000
0
2000 2002 2004 2006 2008 2010
Data as of 5/2011
6. HCV Infection Among Youth in Massachusetts
Starting in 2002, an increase of newly diagnosed HCV
infection has been noted among youth ages 15-25
Between 2002 and 2007, an increase of 73 to 127 cases
per 100,000 population was reported in this age group
MDPH has received over one thousand newly
diagnosed cases in this age group annually since 2007
Data suggest the increase is due to youth injecting
drugs (mostly heroin)
7. MMWR: Rates of newly reported cases of hepatitis C virus infection (confirmed and
probable) among persons aged 15--24 years and among all other age groups ---
Massachusetts, 2002--2009
8. MMWR: Age distribution of newly reported
confirmed cases of hepatitis C virus infection ---
Massachusetts, 2002 and 2009
* N = 6,281; excludes 35 cases with missing age or sex information.
† N = 3,904; excludes 346 cases with missing age or sex information.
Source: Onofrey et al MMWR: May 6, 2011 / 60(17);537-541
9.
10. What is the response?
All MDPH-funded HIV prevention and
screening programs providing education and
referral on viral hepatitis
23 programs funded to provide comprehensive
screening, including HIV, HCV and STDs
Provider education
CDC Epi-Aid
Enhanced surveillance
11. Major questions remain
How are cases being introduced to injection
practices?
How can HCV transmission be prevented in this
population?
What does this epidemic look like among those
NOT in care (not diagnosed)?
What is the impact on HIV transmission?
12. Impact of HIV/HCV co-infection
HIV/HCV co-infection has serious negative
consequences
More rapid HCV disease progression
Increased risk of death/liver failure/HCC
More limited HIV treatment options
13. HIV Surveillance in Massachusetts
HIV and AIDS both reportable to MDPH by name
(HIV by name since 1/1/2007)
Funded primarily by CDC cooperative agreement
Data are maintained in a separate non-networked
system
As of 12/1/2008, 18,136 alive HIV/AIDS cases in
Massachusetts
4,870 with history of IDU or MSM/IDU
As seen nationally, newly reported HIV cases attributed to
IDU in Massachusetts have decreased in recent years
14. Data match with HIV/HCV
Data match conducted in January, 2011
Data on reported HCV cases between ages of 15 and
29 years for the period 2005 to 2010 extracted and
provided to HIV/AIDS surveillance staff for match
Following data match, data de-identified for analyses
4,381 HCV cases matched to 29,399 cases of
individuals ever reported with HIV/AIDS.
15. Results of HIV/HCV data match,
Massachusetts, 2005-2010
Age Group # Co-infected % Male % Female
HIV/HCV
15–24 27 56% 44%
years
25-29 38 63% 37%
years
16. Case rates of HIV/HCV co-infection
by county
County N Case rate
(per 100,000 population)
Worcester 15 9.6
Suffolk 8 3.7
Essex 9 6.5
Hampden 8 8.0
Middlesex 6 1.9
17. Discussion
Numbers of HIV/HCV co-infection among people
ages 15-29 years in Massachusetts is small, despite the
evidence for substantial HCV transmission
However, data suggest that HIV is present in some
social networks
May be more concentrated in urban areas, especially in
central Massachusetts
Risk of HIV acquisition may increase with age/duration
of injection
18. Conclusions
HCV transmission among young IDU in Massachusetts
is increasing
HIV/HCV co-infection is evident in this population
Numbers are currently small, suggesting opportunity to
prevent HIV infection in this population
Implementing effective HCV and HIV prevention
programs and systems for this population is critical
HCV prevention in this population is complex and requires
innovative and fully integrated programs
HCV prevention is HIV prevention
Programs should include screening for both HIV and HCV
19. Conclusions - 2
Surveillance for HIV and HCV infection is
essential for tracking this syndemic
Funding needed to support HCV surveillance in all
jurisdictions
Increased surveillance on all co-infected cases
indicated
20. Finally…
Decreased HIV transmission among IDU
nationally does not mean that risk of acquisition
is absent – expansion and integration of
prevention programs for young drug users
should be a high priority