Identifying Spatial Clusters of HIV-Hepatitis Co-Infection to Effectively Target Intervention Programs

Aerial view of Los Angeles
Aerial view of Los Angeles
Researchers sought to identify spatial clusters of HIV-HBV/HCV co-infection in Washington DC and compare them with the high-risk clusters of people are not co-infected with HBV/HCV.

Identifying high-risk geographic areas in the United States for HIV and hepatitis co-infection is useful in order for health departments to effectively target intervention programs for combatting these epidemics, according to an analysis published in PLoS One.1

In people living with HIV infection in the United States, approximately 10% are co-infected with hepatitis B virus (HBV) and 25% are co-infected with hepatitis C virus (HCV).2 These co-infections increase the risk for serious, life-threatening complications and may also complicate the delivery of anti-retroviral therapy.1

The estimated prevalence of HIV in Washington, DC, is 1.9%, which exceeds the World Health Organizations definition of 1% for generalized epidemics.3 While the majority of HIV studies focus on the prevalence of morbidity or premature mortality, they do not identify high-risk areas for public health intervention programs, particularly in resource-limited settings.1 Thus, researchers sought to identify spatial clusters of HIV±HBV/HCV co-infection in Washington, DC, and compare them with the clusters of high-risk people who are not co-infected with HBV/HCV.

The researchers found that between 1980 and 2016 HIV was diagnosed in 12,965 people, 2316 of  whom were also co-infected with hepatitis (n=590, HBV co-infection; n=1726, HCV co-infection).

In Washington, DC, 3 high-risk geographic clusters were identified which require enhanced hepatitis and HIV prevention, treatment, and care. They also found that injection drug users and men who have sex with men were the populations with the highest transmission rates. Blacks were reported as making up 83.64% of the co-infected population.

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The investigators concluded that “The findings from this analysis will be used to target [area-] based public health policy and healthcare interventions for HIV-hepatitis.”


  1. Das S, Opoku J, Allston A, Kharfen M. Detecting spatial clusters of HIV and hepatitis coinfections. PLoS One. 2018;13(9):e0203674. doi:10.1371/journal.pone.0203674
  2. Centers for Disease Control and Prevention (CDC). Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2001;50(RR11);1-42.
  3. District of Columbia Department of Health. Annual Epidemiology and Surveillance Report. Published 2018. Accessed October 16, 2018.