Co-infections of Hepatitis C or Tuberculosis Among Persons Living with HIV in The Florida Cohort Project
Alexander Zirulnik MPH, Chukwuemeka Okafor MPH, Akemi Wijayabahu, Zhi Zhou MPH,
Jennifer Janelle MD, Ezekiel Ojewale MD MPH, Robert Cook MD MPH for the Florida Cohort Investigators
Background
Results
Florida has the highest incidence of new HIV infections in the
country with a rate of 31.4% and increasing each year (Florida
Charts, 2014). In 2014, newly reported HIV infections were
distributed among 47% African Americans, 21% Hispanic, 30%
White, and 2% other. High risk groups of HIV infection are African
American, men who have sex with men (MSM), injection drug
users (IDU) and young adults with risky behavior (alcohol and drug
use).
Chronic Hepatitis-C (HCV) account for 25% and Hepatitis-B
infection account for 10% of co-infections in people living with HIV.
Hepatitis infection has serious, life threatening conditions mostly
pertaining to liver complications (AETC, 2015). Thus the Center for
Disease Control has recommended vaccination against HBV and
early detection of HBV and HCV. Unlike HBV, HCV does not have
prophylaxis vaccines. IDU has been recognized as the major reason
to acquire HCV in Florida, according to Florida Charts, 2013. When
compared to Hepatitis co-infections, overall TB incidence has been
decreased in Florida. Among Tuberculosis (TB) infected people,
8.9% are co-infections with HIV. Both major co-infections (HCV and
TB) are disproportionately distributed among racial and ethnic
minority groups in Florida. These co-infections continue to be
clinical and are research priorities as it pertains to persons living
with HIV. The purpose of this project is to examine any trends of
co-infections among racial minorities in the Florida Cohort.
Positive
(-VL)
Hispanic
82%
9%
4%
Positive
(Unknown
VL)
5%
Not Hispanic,
Black
Not Hispanic,
White
82%
12%
<1%
6%
72%
11%
3%
14%
Discussion/Conclusion
Methods
The Florida Cohort was initiated in 2014 as part of the NIAAAsupported Southern HIV Alcohol Research Consortium (SHARC).
Recruitment began in October of 2014 and currently includes urban
(UF Health Shands, Orange, Hillsborough, Broward, and Miami-Dade
Counties) and rural (Alachua, Sumter and Columbia Counties) sites.
Participants completed a baseline survey that asked the m to selfreport a history of HCV or TB positive test results. See below:
“Question 6. Have you ever been diagnosed with tuberculosis
(TB), or been told you have a positive skin test (sometimes called a
PPD) or a positive tuberculosis blood test (called a Quantiferon Gold
or T-spot test)?”
“Question 7. Have you ever been tested for Hepatitis C (Hep C)?”
Participants’ information is further linked to medical records and
statewide HIV surveillance data for confirmation.
Co-infection status of first 575 persons enrolled were compared to
the overall HIV positive population in Florida.
Dependent Variable:
Proportion of people in HIV cohort having HCV and TB positive test
results
Independent Variable:
HCV and TB Co-Infection status (positive test results)
Covariates
Gender, race and Ethnicity
HCV Status Confirmed by Labs (n=206)
(% within each race/ethnicity)
Race/Ethnicity Negative
Positive
(+VL)
Florida Cohort Tuberculosis History (n=541)
(% within each race/ethnicity)
Race/Ethnicity No
Yes
Not Sure
Hispanic
Not Hispanic,
Black
Not Hispanic,
White
79%
16%
5%
78%
18%
4%
92%
6%
2%
Florida Cohort Hepatitis C Screening History (n=545)
(% within each race/ethnicity)
Race/Ethnicity None
Yes –
Yes –
Result was Result was
Positive
Negative
Hispanic
8%
21%
66%
Not Hispanic,
Black
Not Hispanic,
White
Not Sure
5%
15%
23%
48%
14%
12%
18%
61%
9%
• The Florida Cohort strives to represent an accurate
representation of persons living with HIV in the state of Florida.
• 15% reported a history of a positive Tuberculosis test, while 22%
of the participants reported a positive Hepatitis C result.
• In the Florida Cohort, tuberculosis co-infections are consistent
with state surveillance data that shows TB rates are higher
among minorities living with HIV.
• Hepatitis C co-infections are proportionate among white and
non-white participants in the Florida Cohort.
• However, 14% (higher proportion of minorities) of our study
population reports no history of HCV screening. Further
expansion of HCV screening may result in increased treatment
and resolution of HCV infections.
• Over 10% of our sample have current, active HCV co-infections
that could be cured/resolved.
• As objective medical record abstraction increases among all
participants in the Florida Cohort, a more accurate picture of coinfections will be presented.
Strengths/Limitations
• Self-reported measures from the Florida Cohort Survey remain
the largest study limitation. However, using future laboratory
results and confirmatory tests from medical abstractions (in
progress), we hope to ascertain a more accurate diagnosis and
screening history of all participants.
Acknowledgement
• Chang, C.C., Crane, M., Zhou, J., Mina, M., Post, J.J., Cameron,
B.A., Lloyd, A.R., Jaworowski, A., French, M.A. and Lewin, S.R.,
2013. HIV and co‐infections. Immunological reviews, 254(1),
pp.114-142.
• Funding support: NIAAA U24022002