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HCV and HIV Co-Infection among Adolescents and Young Adults in Massachusetts: Implications for Prevention
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HCV and HIV Co-Infection among Adolescents and Young Adults in Massachusetts: Implications for Prevention


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  • 1. HCV and HIV Co-Infectionamong 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 Probable7000600050004000300020001000 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. 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
  • 10. 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?
  • 11. 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
  • 12. 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
  • 13. 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.
  • 14. Results of HIV/HCV data match, Massachusetts, 2005-2010Age Group # Co-infected % Male % Female HIV/HCV 15–24 27 56% 44% years 25-29 38 63% 37% years
  • 15. 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
  • 16. 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
  • 17. 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
  • 18. 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
  • 19. 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