Associated Studies

Fibroscan

Fibroscan is a test used for evaluating changes in the liver. The technique is used to measure hepatic fibrosis in a totally non-invasive and painless manner, with no risks for the patient. The examination consists of the patient lying on his or her back, with right arm raised. The probe is placed between the ribs on the right lobe of the liver. High frequency sound waves are generated and measured as they pass through the liver. The measurement is represented in pressure (kPa) Our overall objective is to use fibroscan results as a method of determining liver fibrosis in chronic HCV- HIV co-infection. Specific Aims: 1. Validate Transient Elastography (FibroScan) for predicting fibrosis progression by comparing their performance to rates obtained from single liver biopsies. 2. Estimate the effect of ART on fibrosis progression using fibroScan results. 3. Estimate effect of HCV treatment on fibrosis progression using fibroScan results.

Food Security CTN 264

Food insecurity exists when access to nutritious food is limited or uncertain, for example, worrying that food will run out before one can buy more or skipping meals because there is not enough money for food. These situations may affect a person’s health. It is known that food insecurity is common among persons living with HIV, but there are few studies looking at access to food and HIV-HCV co-infection. Food Security and HIV-HCV Co-Infection (FS/HIV-HCV) is a sub-study of the Canadian Co-Infection Cohort (CCC). The main objectives of this sub-study are to: 1. understand the relationship between a. levels of food security, b. behavioural and clinical factors related to HIV-HCV co-infection (e.g., drinking habits, substance use, CD4 count, HCV genotype), and c. health-related quality of life and health and treatment outcomes (e.g., perceived health, HIV treatment adherence). 2. examine how food insecurity affects a person’s experience of co-infection. First, a questionnaire on food security is administered every six months as part of the CCC study visits. Later, eligible participants who accepted to be contacted will be asked to participate in an interview. All participants receive a guide to local resources, a cookbook with easy-to-do recipes using healthy and low-cost ingredients and $10 for compensation. Results from this study will be important in improving the health of co-infected persons who are experiencing food insecurity. The FS/HIV-HCV sub-study is lead by a Canadian research team with diverse backgrounds including nutrition, medicine, psychiatry and public health. It is funded from both the Canadian Institutes of Health Research (CIHR) and the CIHR Canadian HIV Trials Network (CTN).

Proteomics

Our overall objective is to identify biomarkers which are predictive of liver fibrosis in chronic HCV- HIV co-infection and that provide prognostic and pathogenic information that may help elucidate the mechanisms underlying accelerated fibrosis in the setting of HIV infection. Specific Aims: 1. To apply high throughput clinical proteomics tools to identify novel serum biomarkers and biomarker patterns associated with fibrosis in HIV-HCV co-infected individuals and HCV mono-infected controls. 2. To validate these biomarkers and calculate the sensitivity, specificity, positive and negative predictive values for the detection of significant hepatic fibrosis compared to liver biopsy (the current gold standard). 3. To compare proteomic profiles in HIV-HCV co-infected and HCV mono-infected controls at similar fibrosis stages to determine if protein profiles are expressed differently. 4. To compare serum biomarkers with ongoing immunologic and non-invasive marker studies.

Inflammatory Biomarkers

An increasing number of people are infected with both Hepatitis C (HCV) and HIV. HIV makes HCV related liver disease progress more rapidly. Liver disease is now one of the leading causes of illness and death in HIV-HCV-infected persons despite effective HIV treatment. One possibility is that ongoing inflammation contributes to liver disease as has been shown for other health outcomes among HIV infected persons such as heart disease. We will use the cohort to study how inflammation may contribute to liver disease over time and to assess how HIV and HCV treatments may affect the inflammatory response. Several inflammatory markers that have been linked to liver scarring will be measured before and after antiviral treatment and treatment interruption. This work will allow a greater understanding of how antivirals may play a role in improving liver scarring and will provide insights into how best to develop and target antiviral and anti-inflammatory therapies towards a goal of improving liver health among persons living with HIV and HCV co-infection.

Raltegravir Switch

Study researchers believe that switching to raltegravir will reduce the rate of liver fibrosis progression. Raltegavir has a favorable liver safety and metabolic profile (e.g., cholesterol) although it has not been widely studied in the setting of co-infection. The study objective is to assess if switching from ritonavir boosted-PI based ART regimen to a raltegravir-based regimen will reduce the rate of hepatic fibrosis progression in HIV-HCV co-infected patients as measured by transient elastography (FibroScan®) and the AST-to-platelet ratio index (APRI) after 48 weeks of treatment.