This study analyzed surveillance data from 2000-2009 in DC to examine the impact of chronic HCV co-infection on HIV clinical outcomes. It found that 11.3% of reported HIV cases were co-infected with HCV. Co-infected individuals were more likely to be black, over age 40, and infected through injection drug use. They had lower CD4 counts at most recent tests and higher mortality, even after adjusting for covariates. While over half of co-infections were with HCV first, co-infection negatively impacts HIV disease progression. Improved data and prevention/treatment programs for high-risk groups are recommended.
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
Martin Holt (NCHSR) discusses the findings of the Gay Periodic Surveys and concludes that support services will increasingly face ageing and sexuality issues with HIV-positive gay men, and that tradtionally oriented services may find it harder to engage with HIV-negative gay men. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Prevention and Care Framework and Priorities
Epidemiology of HIV in the EMA
HIV continuum of care in the Chicago EMA – linkage to care, engaged in care and viral suppression
Reaching the NHAS goals
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
Martin Holt (NCHSR) discusses the findings of the Gay Periodic Surveys and concludes that support services will increasingly face ageing and sexuality issues with HIV-positive gay men, and that tradtionally oriented services may find it harder to engage with HIV-negative gay men. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Prevention and Care Framework and Priorities
Epidemiology of HIV in the EMA
HIV continuum of care in the Chicago EMA – linkage to care, engaged in care and viral suppression
Reaching the NHAS goals
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.
Presented by Michael Horberg, MD, MAS, FACP, FIDSA,
Executive Director Research, Mid-Atlantic Permanente Medical Group, Director, HIV/AIDS Kaiser Permanente, at the 2012 National Chlamydia Coalition meeting.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This presentation discusses:
Why it is a Global Health Issue?
Difference between HIV and AIDS?
Signs and Symptoms
Routes of Transmission
Risk factors
Diagnosis
Prevention
Treatment
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This talk is being delivered on June 19th 2012 as part of CBI's 3rd Annual Social Media Regulations and Compliance Conference in Arlington, Virginia: http://www.cbinet.com/brochures/PC12028_brochure.pdf
Michael Atkinson, (WA AIDS Council) describes development and progress of the only peer-based sexual health screening clinic in Australia: the M Clinic. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Presented by Michael Horberg, MD, MAS, FACP, FIDSA,
Executive Director Research, Mid-Atlantic Permanente Medical Group, Director, HIV/AIDS Kaiser Permanente, at the 2012 National Chlamydia Coalition meeting.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This presentation discusses:
Why it is a Global Health Issue?
Difference between HIV and AIDS?
Signs and Symptoms
Routes of Transmission
Risk factors
Diagnosis
Prevention
Treatment
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This talk is being delivered on June 19th 2012 as part of CBI's 3rd Annual Social Media Regulations and Compliance Conference in Arlington, Virginia: http://www.cbinet.com/brochures/PC12028_brochure.pdf
Michael Atkinson, (WA AIDS Council) describes development and progress of the only peer-based sexual health screening clinic in Australia: the M Clinic. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Kharfen: DC HIV Public-Private Partnershipshealthhiv
Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
Martin Holt (Senior Research Fellow, NCHSR), outlines findings from NCHSR studies of living with HIV: the Straightpoz Study (positive heterosexuals & their partners); and the Gay Community Periodic Surveys: HIV-positive gay men.
This presentation was given at the AFAO Positive Services Forum 2012.
David L. Wyles, MD of UC San Diego Department of Medicine presents"Acute HCV Infection in HIV+ MSM: Sexual Transmission of a Non-Sexually Transmitted Disease?"
Programs to improve infant and young child nutrition in the context of HIVRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Rene Ekpini
Trevor Hawkins, M.D., M.P.H. of the Univeristy of New Mexico and Southwest CARE Center, presents "Top Ten HIV Clinical Controversies 2014" at AIDS Clinical Rounds
Kathleen Brady of the PDPH presented the annual report on the HIV epidemic in Philadelphia at the February 2017 meeting of the Philadelphia Ryan White Part A Planning Council.
Core practices that are moving from a pilot state to implementation at scale: Many of the
barriers facing HIV programs are common across countries. PEPFAR’s ECTs (described below in
Sections 2.3.2 and 2.3.3) identified common issues affecting countries at various levels of
epidemic control and then developed a compendium of evidence-based solutions, approaches
and case-studies that highlight successful means of addressing common barriers. Additional
evidence-based approaches and case-studies will be incorporated into this living compendium
over time. As highlighted in this PEPFAR Solutions Platform, these practices can be rapidly
adapted and scaled to move countries forward.
Key considerations for all PEPFAR programs include:
• Bringing Interventions to Scale with Fidelity: Getting to HIV epidemic control is dependent on
several factors; not the least of which is the ability to rapidly scale successful interventions with
fidelity and demonstrated impact. However, the logistics of cost- effective programmatic scale
have proven challenging, with several implementation barriers. Implementation science
defines scalability as the capacity to expand or extend an intervention to account for a growth
factor that aims to fill a gap or address unmet need in a defined population group/geographic
area.
• Data and Information Technology: The enabling environment for data and information
technology is rapidly maturing across countries, creating space, opportunity, and needed
political will to harness the Data Revolution for epidemic control. OUs should consider
innovative ways to use data and information technology to improve efficiency and
sustainability in achieving epidemic control, beyond immediate PEPFAR indicator data
collection needs. As highlighted in the Data Revolution Innovation Toolkit, available on the
PEPFAR SharePoint, OUs are encouraged to explore, adapt, and scale these and other data
driven approaches to move country epidemic control forward.
AACO's Annual Client Services Unit, Housing, and Quality Management PresentationOffice of HIV Planning
Evelyn Torres and Sebastian Branca presented on Philadelphia's AIDS Activities Coordinating Office's Client Services Unit, Housing Services Program, and Quality Management program at the February 6, 2013 meeting of the Needs Assessment Committee of the Philadelphia EMA Ryan White Planning Council.
Similar to Impact of Chronic HCV Co-infection on HIV Clinical Outcomes in the District of Columbia (20)
In the Know II: What's New In Image & Video Sharing?CDC NPIN
Presentation from the In the Know 2: Social Media for Public Health webcast held on March 19, 2014 by CDC NPIN staff. The webcast offered public health professionals a look at the latest features, functions, and practices on popular and emerging image and video social media channels.
In the Know 2: Whats New in Social Media? CDC NPIN
Presentation from the In the Know 2: Social Media for Public Health webcast held on March 6, 2014 by CDC NPIN staff. The webcast offered public health professionals a look at the latest features, functions, and practices on popular and emerging social media channels.
Using What You Know about Social Media: How to Conduct a Twitter ChatCDC NPIN
This is the 1st in our newest online training opportunity for public health professionals: Using What You Know about Social Media - How to Conduct a Successful Twitter Chat!
In the Know II: Creating Your Social Media PlanCDC NPIN
This presentation was used in a webcast that offered public health professionals the methods to successfully create a social media plan. How do you truly connect with your target audience? Developing a plan is one of the first and most important aspects of an engagement strategy. The right plan has many facets that work together to increase the likelihood of success.
In honor of World AIDS Day 2013 and to ensure we always remember those no longer with us, CDC NPIN is proud to host 15 sections of the Names Project AIDS Memorial Quilts. Each panel underscores commitment and effort to end this pandemic.
NPIN's In the Know: Social Media for Public Health Webcast Series PosterCDC NPIN
In the Know is a live, interactive webcast series designed to provide the latest in social media to support public health success. The first series of webcasts wrapped up in June, 2013.
CDC NPIN In the Know: Social Media Measurement and Evaluation for Public Heal...CDC NPIN
This is the sixth part of interactive webcasts in this round of the series, In the Know: Social Media for Public Health. Each webcast focuses on a different social media channel and provides basic information, tips, success stories, and discussion on how best to use social media to promote public health and expand outreach initiatives.
CDC NPIN In the Know: Google Plus & YouTube for Public HealthCDC NPIN
This is the fifth of six interactive webcasts in the series, In the Know: Social Media for Public Health. Each webcast focuses on a different social media channel and provides basic information, tips, success stories, and discussion on how best to use social media to promote public health and expand outreach initiatives.
CDC NPIN In the Know: Facebook & Visual Social Media for Public HealthCDC NPIN
This is the fourth of six interactive webcasts in the series, In the Know: Social Media for Public Health. Each webcast focuses on a different social media channel and provides basic information, tips, success stories, and discussion on how best to use social media to promote public health and expand outreach initiatives.
CDC NPIN In the Know: Gaming & Mobile for Public Health Webcast PresentationCDC NPIN
This is the third of six interactive webcasts in the series, In the Know: Social Media for Public Health. Each webcast focuses on a different social media channel and provides basic information, tips, success stories, and discussion on how best to use social media to promote public health and expand outreach initiatives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Impact of Chronic HCV Co-infection on HIV Clinical Outcomes in the District of Columbia
1. Impact of Chronic HCV Co-infection
on HIV Clinical Outcomes in the
District of Columbia
Sarah Willis, MPH
Department of Epidemiology and Biostatistics
School of Public Health and Health Services
The George Washington University
2011 National HIV Prevention Conference
2. A Public Health/Academic Partnership
between the
District of Columbia Department of Health
and
The George Washington University School of
Public Health and Health Services
Department of Epidemiology and Biostatistics
Contract Number POHC-2006-C-0030
3. Background
• An estimated 1/4 of those infected with HIV are
also infected with hepatitis C virus (HCV)
• Estimates of HIV/HCV co-infection range from 50-
90% among certain sub-populations
• Supporting evidence that HIV negatively impacts
HCV disease progression and reduces the
effectiveness of available treatments
4. Background (2)
• Less research has been conducted regarding
role of HCV co-infection on HIV disease and
existing studies have conflicting results
– Association between HCV/HIV co-infection and
worsening liver disease and higher mortality
when compared to those with HIV or HCV
monoinfection (Merriman et al)
– HCV co-infection associated with blunted CD4
cell recovery after initiating HAART yet no effect
on virologic response or mortality (Carmo et al)
5. Objectives
Utilize routinely reported surveillance data to:
1. Determine the extent of HIV/HCV co-infection
in the District of Columbia between 2000-2009
2. Describe potential factors that may be
associated with HIV/HCV co-infection
3. Determine the impact that HIV/HCV co-
infection has on HIV clinical outcomes and
mortality
6. Methods
• Identified name-based HIV/AIDS cases diagnosed
and reported to the DCDOH between 2000 – 2009
(n=10,215)
• Identified chronic HCV cases reported to DCDOH
during the same time period (n=16,235)
• Used Link Plus Probability matching program to
match cases by:
– First and last name
– Date of birth
– Sex
– Race
• Reviewed potential matches for accuracy
7. Methods (2)
• Performed bivariate analyses to detect differences
among HIV/HCV co-infected and HIV mono-infected
individuals based on:
– Demographics
– Entrance into HIV Care (time between HIV/AIDS diagnosis
and first VL or CD4 test reported to DCDOH)
– Engagement in HIV Care
• Continuous Care - evidence (e.g. HIV-related lab test) of at least 2
visits to an HIV medical provider 10-14 weeks apart
• Sporadic care - one visit to a provider or 2 visits but more than 14
weeks apart
– Viral load and CD4 count (at time of diagnosis and most
recent results)
– Mortality
8. Methods (3)
• Assessed timing of HIV/HCV co-infection
• Association between HIV/HCV co-infection
and mortality (time to death) examined
through:
– Kaplan-Meier log rank test/log rank survival plots
– Cox proportional hazard ratio model
9. Demographics of Co-Infected
and Monoinfected Cases
11.3% of reported HIV cases were HCV co-infected
HIV/HCV HIV
Chi-square
Co-infected Monoinfected
p-value
(n=1,151) (n=9,017)
Sex
Male 67.2% 70.5% 0.0189
Female 32.8% 29.5%
Race/ethnicity
White 4.5% 14.4%
Black 90.4% 77.5% <0.0001
Hispanic 3.1% 5.8%
Other* 2.0% 2.3%
*Other race includes Asian, Alaska Native, American Indian, Native Hawaiian,
Pacific Islander, and Mixed and Unknown race
10. Age and Vital Status of
Co-Infected and Monoinfected Cases
HIV/HCV HIV
Chi-square
Co-infected Monoinfected
p-value
(n=1,151) (n=9,017)
Age at HIV diagnosis
13-19 0.2% 3.1%
20-29 3.7% 20.6%
30-39 13.9% 32.4% <0.0001
40-49 48.1% 28.1%
50-59 28.8% 11.8%
≥60 5.3% 4.1%
Vital Status*
Alive 80.5% 88.5% <0.0001
Dead 19.5% 11.5%
*as of December 31st, 2009
11. HIV Mode of Transmission
45.0%
40.3%
40.0%
36.4%
Proportion of Diagnosed Cases
35.0%
31.6%
30.0%
25.0% 23.5%
20.0% 17.6% 17.2%
15.0% 12.1% 13.8%
10.0%
4.6%
5.0% 2.6%
0.0%
MSM IDU MSM/IDU Heterosexual Risk Not
Identified
HIV/HCV Co-infected HIV
12. Timing of HIV/HCV Infection
Concurrent
Infections
(< 3 months
apart)
27.1%
HCV Infection
3+ months
prior to HIV
58.7% HIV Infection
3+ months
prior to HCV
14.2%
13. HIV Care Seeking Behavior
HIV/HCV HIV
Chi-square
Co-infected Monoinfected
p-value
(n=1,151) (n=9,017)
Entrance into Care
< 3 months 56.9% 59.9%
3 – 6 months 5.7% 4.6%
<0.0001
6 – 12 months 6.3% 5.6%
> 1 year 25.0% 20.4%
Not in care 6.0% 9.5%
Engagement in Care
No care 6.0% 9.5%
<0.0001
Sporadic Care 57.7% 61.4%
Continuous Care 36.3% 29.1%
14. HIV Viral Load at Time of HIV Diagnosis
100,000
90,000
Median Viral Load at Diagnosis
80,000
70,000
(copies/mL)
60,000
50,000
40,000
30,000
20,000
16,406
10,000 10,551
0
HIV/HCV Co-infection HIV only
Kruskal Wallis; p = 0.3031
15. Most Recent Viral Load Results
3,500
3,000
2,500
2,000
1,500
1,000
500
0 74 74
HIV/HCV coinfection HIV only
Kruskal Wallis; p = 0.0119
16. CD4 Count at HIV Diagnosis
500
450
Median CD4 Count at Diagnosis
400
350
300
(cells/µL)
250
200 192
185
150
100
50
0
HIV/HCV coinfection HIV only
Kruskal Wallis; p-value = 0.3986
17. Most Recent CD4 Results
700
600
Median CD4 Count (cells/µL)
500
445
400 389
300
200
100
0
HIV/HCV coinfection HIV only
Kruskal Wallis; p-value = 0.0002
18. Survival Among
HIV/HCV and HIV only cases
HIV only cases
HIV/HCV co-infected cases
Log-rank = 47.35
p-value = <0.0001
19. Adjusted Hazard Ratio for
Mortality among HIV/HCV Co-infected Cases
Adjusted Hazard 95% Confidence
Ratio† Interval
HCV/HIV vs. HIV only 1.20 1.02, 1.40
†Adjusted for sex, race/ethnicity, age, engagement in care, HIV mode
of transmission, and progression to AIDS
20. Conclusions
• More than half of HIV/HCV co-infections were
infected with HCV first
• In comparison to HIV monoinfected cases, HIV/HCV
co-infected cases in DC were more likely to be:
– Black
– Over 40 years of age
– IDU
• HIV/HCV co-infected cases in DC may have poorer
HIV clinical outcomes over time
– Lower CD4 counts among HIV/HCV co-infected cases at
most recent test
– Increased mortality among HIV/HCV co-infected cases
21. Limitations
• May have underestimated HIV/HCV co-
infections due to errors in data entry, name
changes or incorrect spelling
• Large proportion of cases with missing CD4
and viral load data at diagnosis and at follow-
up (25%-75%) in eHARS, could not assess their
clinical outcomes
22. Recommendations
• Subsequent studies should be conducted to better
understand the impact of HCV co-infection on HIV
disease
• Studies utilizing surveillance data for this purpose
should:
– Improve completeness of VL and CD4 test results data
– Obtain data on ART utilization
• Prevention and treatment interventions should be
developed for sub-populations with high rates of
HCV/HIV co-infection, such as IDUs
23. Acknowledgments
DC DOH HIV/AIDS, George Washington
Hepatitis, STD, TB University School of
Administration Public Health and Health
– Angelique Griffin* Services
– Yujiang Jia – Amanda D. Castel*
– Gregory Pappas – Irene Kuo*
– Rowena Samala – Alan Greenberg
– Tiffany West*
*Co-authors