HIV meets Hep C

HIV and hepatitis C risk factors and coinfections explored in Yale study of a Northeast city

/ Author:  / Reviewed by: Dominique Brooks, M.D

(RxWiki News) Many people infected with HIV or hepatitis C aren’t aware of their infections. These unknown infections can strike especially hard in underserved and poor communities.

A recent study from a team of Yale researchers explored these two diseases in the United States’ urban Northeast and found that the viruses share similar risk behaviors for transmission, but different demographic associations.

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According to the authors, led by Jamie P. Morano, MD, MPH, of the Department of Internal Medicine at the Yale School of Medicine, “Hepatitis C (HCV) and HIV represent two highly prevalent chronic viral infections worldwide and the two most prevalent chronic viral infections in the United States...but household surveys do not include the high risk homeless or criminal justice populations.”

The researchers aimed to explore rates among an underreported population by utilizing data from a free mobile medical clinic. The clinic offered a variety of healthcare services in four different impoverished New Haven, Connecticut neighborhoods.

The data used consisted of health screenings and intake assessments, which included risk assessment and demographic questions, from 7,473 people between January 2003 and July 2011.

The researchers identified 601 individuals with HIV infections (8.0 percent) and 753 individuals with hepatitis C infections (10.1 percent).

Of those with hepatitis C, 26.1 percent had a coinfection with HIV, and 32.1 percent of the HIV patients had a hepatitis C coinfection.

The authors noted that a coinfection with these viruses makes treatment and health problems more complicated and serious.

Infection with either or both of the viruses was associated with the use of crack cocaine, increasing age, men having sex with men and patients not having completed a high school education.

Those coinfected with both HIV and hepatitis C were more likely to be “baby boomers” (someone born between 1945 and 1965), be unemployed, be born in the US, have a history of mental health diagnosis and be an injected-drug user.

Infection with only hepatitis C was associated with having health insurance, a history of domestic violence and being ethnically Hispanic. Infection with only HIV was associated with having a history of syphilis and being ethnically Black.

The authors highlighted these ethnic differences as well as behavioral and geographical differences found, saying that based on the data, “[C]ommunities may consider targeted screening in settings where such social and medical comorbidities exist to increase access to treatment for this population, who if left untreated, will eventually develop end-stage liver disease, hepatocellular carcinoma and potentially require costly transplantation.”

The authors also noted that the high presence of crack cocaine use in those infected with HIV, hepatitis C or both should be a focus of treatment, education and public health programs.

The authors concluded that the different associations found “...have important implications for screening, linkage to care, and provision of treatment for these diverse populations that share traditionally common risk factors.”

It is important to note that the study showed no causal relationship, but simply an association, and the data comes from those seeking health care at a mobile clinic exclusively in the city of New Haven.

The study was published May 14 by the Public Library of Science’s journal, PLoS ONE. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
May 21, 2013
Last Updated:
August 28, 2013