Nearly 75% of HIV-Positive Homeless in San Francisco Have Hepatitis C Coinfection, Study Says

Approximately 74% of HIV-positive homeless or "marginally housed" people in San Francisco also have hepatitis C, according to study published in the Journal of General Internal Medicine, the San Francisco Chronicle reports. Researchers from the University of California-San Francisco and San Francisco General Hospital tested and interviewed 249 HIV-positive people recruited from shelters, soup kitchens and single-room occupancy hotels. All participants qualified for free treatment in the city's public health system because of their HIV-positive status, according to the Chronicle. Researchers found that 69% of the participants originally tested positive for hepatitis C, and after three years of follow-up, 74% had hepatitis C coinfection. Researchers found that only 4% of participants with hepatitis C were receiving treatment for the disease. Although the study did not intend to determine how many HIV-positive participants with hepatitis C coinfection "actually needed treatment," researchers said that the number is "surely much higher than what was found" in the study, the Chronicle reports. Dr. Christopher Hall, lead author of the study and an infectious diseases fellow at UCSF, said, "There is a profound lack of treatment. That's the big surprise. Had we looked at a population that was out of the health care loop, that lack of treatment would be more intuitive." He added that the situation is "undoubtedly worse" in other U.S. cities that do not have a public health system similar to San Francisco, according to the Chronicle.

Treatment
Hall said, "Theoretically at least, there's more of a potential for the spread of infection than you would have if you were more aggressive about treating this population." Dr. David Bangsberg, senior author of the study, associate professor at UCSF and director of San Francisco General's Epidemiology and Prevention Interventions Center, said that the results indicate a "longtime indifference to chronic liver disease in the poorest of the urban poor," according to the Chronicle. He said that the hospital has begun to address the problem of HIV-hepatitis C coinfection, but he added that it is "too soon" to see results "on the streets," the Chronicle reports. According to Bangsberg, "One of the broader issues here is that this city has done a great job making sure everyone, regardless of housing status and income, is getting high-quality care for HIV. The city has not done the same in making sure there's access to treatment" for hepatitis C (Hall, San Francisco Chronicle, 4/2).

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