Co-infections
HIV and other infectious disease co-infections
Risk factors for HIV infection are common to other diseases, namely other STDs (such as
chlamydia, gonorrhea and syphilis), hepatitis B and hepatitis C. Also, having an STD may make
an individual more susceptible to HIV infection and vice versa. Although Minnesota is
considered a low to medium incidence state for chlamydia, gonorrhea and syphilis, many
people infected with these STDs are also at risk for acquiring HIV.
HIV and STD co-infection
In the state of Minnesota, laboratory-confirmed infections of chlamydia, gonorrhea, syphilis,
and chancroid are monitored by MDH through a passive, combined physician and laboratorybased surveillance system. State law (Minnesota Rule 4605.7040) requires both physicians and
laboratories to report all cases of these four bacterial STDs directly to MDH. In 2002, MDH
added an active component to the surveillance system for chlamydia and gonorrhea infections,
and in 2008 changed the case report form to include gender of sexual partners and country of
origin to better describe STDs in Minnesota. In addition to the regular surveillance, additional
behavioral information is collected on syphilis and gonorrhea cases. Other common sexually
transmitted conditions caused by viral pathogens, such as herpes simplex virus (HSV) and
human papillomavirus (HPV) are not reported to MDH. Factors that impact the completeness
and accuracy of the available data on STDs include: level of screening, accuracy of diagnostic
tests, and compliance with case reporting. Thus, any changes in STD rates may be due to one of
these factors, or due to actual changes in STD occurrence.
In 2014, 19,897 chlamydia cases and 4,073 gonorrhea cases were reported to MDH. 64% of
combined chlamydia and gonorrhea cases reported to the MDH were among females and 64%
were among persons aged 15-24. Minnesota has also seen resurgence in syphilis cases reported
to the MDH. In 2014, the number of early syphilis cases (that is, primary, secondary, and early
latent stages) increased by 25% (from 332 cases in 2013 to 416 cases in 2014). Of the 416 cases,
34% reported being co-infected with HIV. Most of these cases had been diagnosed with HIV
before being diagnosed with syphilis.
HIV and viral hepatitis co-infection
People with viral hepatitis also share risk factors for HIV including sexual transmission (in the
case of hepatitis B) and sharing needles (in the case of hepatitis C). In 2014, there were an
estimated 22,967 people living in Minnesota with hepatitis B, and 43,543 living with past or
present hepatitis C. Surveillance data from 2014 indicate that around 11% of people living with
HIV/AIDS are also living with hepatitis B or hepatitis C (4% with hepatitis B and 7% with
hepatitis C). Nationally, it is estimated that one quarter of people living with HIV are also
infected with hepatitis C. Hepatitis B or C co-infection may lead to treatment complications
with HIV/AIDS and vice versa.
Minnesota HIV/AIDS Epidemiologic Profile—Co-Infections
December 2015
HIV and TB co-infection
Tuberculosis (TB) co-infection may also be a problem among persons with HIV/AIDS. TB
infection after HIV diagnosis is considered to be an AIDS-defining condition. In 2014, 147 new
cases of TB were reported in Minnesota, and there were 250 documented cases of people living
with TB or receiving treatment for TB. At least 153 (2%) of persons living with HIV/AIDS in
Minnesota indicated TB co-infection at some point (44% with disseminated TB and 56% with
pulmonary TB).
Minnesota HIV/AIDS Epidemiologic Profile—Co-Infections
December 2015