HCV and HIV Co-Infection among Adolescents and Young Adults in Massachusetts: Implications for Prevention
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
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
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
HCV Surveillance in Massachusetts - 2 Viral hepatitis surveillance in Massachusetts is conducted using web-based system (MAVEN)
Reported Cases of HCV Infection in Massachusetts: 2000-2010 Confirmed Probable7000600050004000300020001000 0 2000 2002 2004 2006 2008 2010 Data as of 5/2011
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)
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
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
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
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?
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
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
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.
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
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
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
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
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
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
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