Dec 1st is World AIDS Day - Challenges and Opportunities in Addressing HIV and Viral Hepatitis Coinfection

December 1st is World AIDS Day, established by the World Health Organization in 1988 to raise awareness about HIV and to unite people and countries across the globe around the shared goals of halting the epidemic and improving the health and well-being of people living with HIV. Over time, science, treatment, and programs have advanced and the focus of our efforts has changed in response. Some of the infections that were major causes of death early in the epidemic are now easily prevented or treated and account for relatively few deaths among people living with HIV. Others, like viral hepatitis, have emerged as major threats to the health and survival of people living with HIV. Today we wanted to draw attention to the impact that viral hepatitis is having on the survival of people living with HIV (PLWH).

Of the 1.2 million PWLH in the United States, an estimated one in ten are coinfected with hepatitis B and one in five are coinfected with hepatitis C. Coinfection can occur because HIV, hepatitis B, and hepatitis C have similar routes of transmission – through injection drug use, sexual contact without a condom, and from an infected mother to her infant. Studies show that liver-related deaths are higher in people who are coinfected with HIV and viral hepatitis, suggesting a need for enhanced screening, management, and treatment efforts for people with coinfection.

The opioid epidemic that is gripping parts of the United States is fueling new HIV and viral hepatitis infections. Although baby boomers represent the largest group of people living with viral hepatitis, people who inject drugs are at an increased risk of becoming newly infected with viral hepatitis, as well as HIV infection. Seventy-three percent of PLWH who have a history of injection drug use are coinfected with hepatitis C.  An estimated 26 percent of new hepatitis B cases and 68 percent of new hepatitis C cases occurred in people who report injection drug use. In the 2015 Scott County, Indiana HIV and hepatitis C outbreak, more than 90% of people diagnosed with HIV/AIDS were also living with hepatitis C infection. Without further prevention efforts, at least 220 counties in the United States may be at risk for outbreaks of HIV and viral hepatitis similar to those seen in Scott County. Fortunately, the experience in Scott County shows that when the right prevention, health care, and social services are put in place, this type of outbreak can be brought under control and driven to a halt.

To address help address these challenges, multiple strategies are needed. Some of the tools and resources that are especially relevant for efforts to address HIV and viral hepatitis coinfection include:

• Federal guidelines recommend testing for HIV, hepatitis B, and hepatitis C for all people who use illicit drugs.
• Federal guidelines recommend testing for all PLWH for hepatitis B and hepatitis C.
• Hepatitis B vaccination is recommended for people at risk for or living with HIV/AIDS if they test negative for hepatitis B.
• New hepatitis C treatments have cure rates of over 90%, and are much safer and more effective than previous therapies, especially in people with HIV.
• In many states, the formulary for the AIDS Drug Assistance Program includes coverage for viral hepatitis treatments.
• Integrating viral hepatitis prevention, screening, and treatment into programs for persons living with HIV can also support progress toward the goals of the Action Plan as well as the National HIV/AIDS Strategy.
• New Federal guidance is available for syringe services programs which have been shown to reduce HIV, viral hepatitis, and other blood borne infections among people who inject drugs. 

By applying lessons learned and using the tools and services from the HIV/AIDS response and the response to viral hepatitis, we can improve our work to prevent and treat each infection as well as the overcoming the additional challenges that coinfection presents.  Coordinated and integrated services can help get more people diagnosed, linked to treatment, and most importantly, save lives. Since HHS released the nation’s first Viral Hepatitis Action Plan in 2011, HIV and viral hepatitis coinfection has been identified as an opportunity for coordinated action.

On this World AIDS Day, we encourage everyone affected by HIV to learn more about viral hepatitis coinfection and how each of us can contribute to preventing new infections and improving the lives of those living with HIV.