Spatial epidemiology of HIV-hepatitis co-infection in the State of Michigan: A cohort study

Zahid Butt, Sue Grady, Melinda Wilkins, Elizabeth Hamilton, David Todem, Joseph Gardiner, Mahdi Saeed

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Acquired immunodeficiency syndrome (AIDS) is a continuing global public health threat affecting millions of individuals. In 2009, 33.3 million people worldwide were living with human immunodeficiency virus (HIV) infection. HIVinfected individuals are at an increased risk of acquiring hepatitis B and hepatitis C viral (HBV, HCV)infections because of shared transmission routes. The purpose of this study was to identify geographical clusters of HIV-(HBV/HCV) co-infection in the State of Michigan. Methods: Retrospective cohort data on HIV-infected individuals were matched to all hepatitis B and C cases in Michigan during the period of January 1, 2006 through December 31, 2009. A prevalence map of HIV infection was created and spatial clusters of HIV-hepatitis B or C co-infection were detected using GeoDa fs bivariate local Moran fs I and SaTScan fs discrete Poisson model. Results: A bivariate cluster of high prevalence HIV and hepatitis B or C was identified in the Detroit Metropolitan Area and surrounding counties. A Poisson cluster of HIVhepatitis B or C co-infection was identified, relative risk (RR) = 1.38 (p = 0.029) in the western and northwestern counties of Lower Michigan, controlling for sex, race, and AIDS status. Conclusion: This study identified elevated HIV-hepatitis B or C co-infection unexplained by sex, race or AIDS status in counties outside of the Detroit Metropolitan Area where HIV prevalence was highest in Michigan. The findings from this study may be used to target future public health policy and healthcare interventions for HIV-hepatitis co-infection in these areas.

Original languageEnglish (US)
Pages (from-to)852-861
Number of pages10
JournalInfectious Diseases
Issue number12
StatePublished - 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 Informa Healthcare.


  • Cluster analysis
  • HIV and hepatitis co-infection
  • Hepatitis


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