An epidemiologic update on hepatitis C infection in persons living with or at risk of HIV infection

Abstract

Due to shared routes of transmission, coinfection with both human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) is relatively common and results in accelerated liver disease, driving morbidity and mortality. Deaths related to HCV now exceed deaths related to HIV in the United States, and co-infected patients bear a significant proportion of that mortality. This burden may be addressed by novel antiviral therapies that promise increased rates of cure or by enhanced access to liver transplantation, but these are costly interventions. Ultimately, the future burden of coinfection is addressed by greater understanding of who is at risk for development of each infection, thus guiding preventive efforts. Key recent reports regarding the US burden of morbidity and mortality due to HCV and groups at risk for coinfection are reviewed, with a focus on recently described HCV occurring among young injection drug users and men who have sex with men. Given the lack of available vaccine against HCV, enhanced detection and surveillance is a vital component of our public health strategy to combat HCV.

Figure 1:

Age distribution of newly reported confirmed cases of hepatitis C virus (HCV) infection in Massachusetts for 2002 (A, n = 6368) and 2011 (B, n = 5194). The data confirm the shift previously reported [13] from a unimodal to a bimodal age distribution over this decade. Data are based on case report forms by reporting clinicians, triggered by a positive HCV antibody or HCV viral load test.