S2092 HIV and Hepatitis Co-Infections in Washington, DC: A Syndemic Analysis

Introduction: Syndemics refer to the intersection of co-occurring diseases and social inequities. Washington, DC, with a 2024 estimated population of 702,250, is composed of 46.6% White, 44.4% Black or African American, 12.0% Hispanic or Latino, and 4.9% Asian residents. Despite curative and suppressive therapies for hepatitis B (HBV) and C (HCV), outcomes remain suboptimal in vulnerable populations. This study investigates the epidemiology, treatment gaps, and geographic clustering of HIV-HBV and HIV-HCV co-infections from 2019 to 2023. Methods: We conducted a retrospective analysis using data from the DC Department of Health, including the 2024 surveillance report, appendix tables, and a custom dataset from the HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA). All confirmed HIV-HBV and HIV-HCV co-infections from 2019 to 2023 were analyzed by demographic, geographic, and treatment variables. Broader HIV and viral hepatitis trends were also reviewed for context. Results: Among HIV-HBV co-infections (n = 94), 84% were Black, 79% male, and over half aged 40 to 59. Nearly half resided in Wards 7 or 8. HBV treatment was documented in 78%, with 22% unknown or missing. Among HIV-HCV cases (n = 246), 73% were Black, 86% men, and 36% aged 30 to 39. Wards 5, 7, and 8 were most affected. Only 17% had documented HCV treatment. In 2023, 113 new HBV and 241 new HCV cases were reported. Over 5 years, 310 individuals were cured of HCV, with 78% of those cures occurring after 2021. As of 2023, 11,670 individuals were living with HIV in DC, 70% of whom were Black. Conclusion: HIV-viral hepatitis co-infections in Washington, DC show a clear syndemic pattern. Black residents, who make up 44% of the city’s population, represent over 70% of cases across both HBV and HCV co-infections. Treatment for HBV is inconsistently documented, and HCV treatment remains drastically underutilized despite being curative. Geographic clustering in Wards 5, 7, and 8 reflects broader structural inequities tied to race, income, and healthcare access. These findings underscore the need for integrated, community-based care models and improved surveillance systems. Syndemic-informed strategies are critical to closing treatment gaps in high-burden urban settings.