1. Priscilla Lee Chu, DrPH, MPH San Francisco Department of Public Health XIX International AIDS Conference July 23, 2012 Washington, DC

2.  Program Collaboration and Service Integration (PCSI) has prioritized the integrated monitoring of syndemics among four communicable disease registries:  HIV  Tuberculosis  Viral Hepatitis  STDs 2

3.  Syndemics are the presence of two or more diseases interacting synergistically to exacerbate health outcomes within a population 3

4.  To assess the prevalence of co-occurring infections within the four registries and their impact on persons living with HIV/AIDS (PLWHA) 4

5.  HIV/AIDS cases were matched against seven diseases from three other registries HIV STDSyphilisGonorrheaChlamydia Viral Hepatitis Chronic Hepatitis B Hepatitis C Hepatitis C TB Active TB Latent TB 5

6.  Chi-square, t-test, and Kruskal-Wallis tests were used to assess differences between those with HIV only versus HIV plus at least one co-infection by:  Demographics  Health status  Neighborhood 6

7. HIV14% Syphilis 1% Gonorrhea 2% Chlamydia 2% HCV 4% HBV 4% LTBI 2% Active TB 1%  HIV N=15,056  N=2,050 (14%) with one or more infection in addition to HIV  Syndemic rate 13,616 per 100,000 HIV cases  Highest co-morbidities: HCV, HBV, Chlamydia, and latent TB 7

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14.  Syndemics are associated with poorer HIV health outcomes among PLWHA  Significant “dose-response relationship” between the number of co-infections and mean VLs 14

15.  In addition to numbers of co-infections, particular demographic subgroups, and certain geo-clusters were also associated with poorer health outcomes, underscoring the need to address multiple conditions in tandem in an integrated health system 15

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17. Glenn-Milo Santos Annie Vu Israel Nieves-Rivera Grant Colfax Jennifer Grinsdale Sandra Huang Susan Philip Susan Scheer Tomas Aragon 17