Mortality among people with hepatitis c and HCV/HIV co-infection in New York city, 2000-2011

Background: Persons with hepatitis C (HCV)/HIV co-infection are at greater risk of death than those with HCV only, but the impact of HIV on mortality among people with HCV has not been well studied in New York City (NYC). We analyzed mortality trends and risk of death among persons with HCV alone, and HCV/HIV-co-infection in NYC.

Methods: The NYC Department of Health and Mental Hygiene (DOHMH) implemented CDC's Program Collaboration and Service Integration initiative to better understand the interaction between infectious diseases in NYC. We conducted a retrospective, deterministic cross-match of HIV and HCV surveillance databases with data from 2000-2010, and NYC death registry data from 2000-2011. We examined changes in the proportion of HCV cases with HIV over time, and used survival analysis to compare progression to death in the two groups over the 10-year period, controlling for age.

Results: Of persons diagnosed with HCV in 2000, 8% were diagnosed with HIV. This proportion of co-infected HCV cases increased to 17% in 2010. During the study period, 19% of HCV/HIV co-infected persons died within 3 years of their HCV diagnosis, compared with 9% of persons with HCV only (<.0001). The annual risk of death was 5.5 times higher for co-infected cases compared with the HCV-only group (p<.0001).

Conclusion: Given the higher risk of death among persons with HCV/HIV co-infection, the NYC DOHMH is developing a strategy to improve HCV testing among people with HIV, and to prioritize linkage to medical care for co-infected persons who are not in care.