May 21, 2013
Researchers from Yale University concluded that researchers need to put forth greater effort to screen high-risk individuals to find those coinfected with HIV and hepatitis C virus (HCV). Dr. Jamie Morano of the Yale School of Medicine Department of Infectious Diseases and colleagues reported on a study using data from health screenings by the Yale Community Health Care Van, a mobile medical clinic run by the university.
Of 8,300 people screened from 2003 to 2011, 8 percent had HIV infection, 10 percent had HCV infection, and approximately 26 percent of individuals with HCV were coinfected with HIV. CDC has estimated that 3.4 million to 4.9 million in the United States have HCV infection; they based this estimate on figures from the National Health and Nutrition Examination Survey, which is comprised of household interviews, physical examinations, and tests of serum samples. Dr. Frederick Altice, professor of medicine and epidemiology, and Morano contend that CDC's numbers and those of similar surveys miss two of the most at-risk populations -- the homeless and the incarcerated. They noted that the Yale study questioned individuals about past or present homelessness and incarceration. The authors stated that to find these individuals, researchers have to be creative and proactive and visit the areas where these populations congregate, as they do not readily go to health clinics or volunteer personal information.
The researchers agreed with CDC recommendation that all baby boomers be screened for hepatitis C, but they suggested that screening also should focus on behavioral risk factors. They believed that people who use intravenous drugs, men who have sex with men, and those who did not graduate from high school were most likely to be coinfected with HIV and HCV.
Raul Pino, health director for Hartford, Conn., agreed that aggressive screening was necessary. He commented that many HCV-infected people were unaware of their status. He added that in the past seven months, the mobile healthcare van and the Central Area Health Education Center regularly conducted screenings in different neighborhoods. The south end of the city showed a high concentration of people with HCV, which he suggested was linked to the use of intravenous drugs in those areas in the 1980s and 1990s.
The full report, "The Burgeoning HIV/HCV Syndemic in the Urban Northeast: HCV, HIV, and HIV/HCV Coinfection in an Urban Setting," was published online in the journal PLoS ONE (2013; 8(5): e64321. doi:10.1371/journal.pone.0064321).