THE ISSUE:

Thanks to successful treatments, HIV infection has been transformed into a long-term manageable illness. For people living with HIV, it is often other illnesses and conditions that make them sick and accelerates death. It is therefore important to understand which of these conditions affect the health of people living with HIV.

Hepatitis C, (HCV) is one of these diseases, affecting 30% of people living with HIV worldwide and nearly 15,000 of the 65,000 people living with HIV in Canada. Living with both HIV and HCV can have some serious effects on the liver and can lead to an earlier death.

 

THE RESEARCH:

The Canadian Co-infection Cohort study researches people living with both HIV and HCV in Canada. As of October 2010, the study included 955 participants from 16 health care centers across Canada.

 

THE FINDINGS:

  • Participants in the study were mostly men (77%), living under the poverty line; annual income of less than $24,000 (76%), had a history of incarceration (57%) and injection drug use (81%) and drank alcohol (50%)
  • The majority of participants were taking HIV medication (82%), but only 71% had a suppressed viral load
  • The majority of participants had never received HCV treatment (70%)
  • The number of deaths among the participants was much higher than in the general Canadian population
  • Causes of death were end stage liver disease (ESLD), drug overdose, cancer, and AIDS-defining illness (in order of importance)
  • 50% of participant deaths could have been prevented

 

CONCLUSION:

This study shows that people infected with HIV and HCV in Canada experience a high level of social instability, poverty, mental illness, and alcohol and drug use. These multiple vulnerabilities present important challenges to care and to preventing further illnesses and death.

 

MOVING FORWARD:

Strategies to support the health of co-infected Canadians should include:

  • Programs that improve negative social circumstances
  • Programs that reduce the harms of drugs and alcohol
  • Increasing the delivery of HCV treatments
  • Increasing access to teams of care providers to support both HIV and HCV treatment adherence

 

Publication: Klein MB et al. HIV and Hepatitis C virus coinfection in Canada: challenges and opportunities for reducing preventable morbidity and mortality, HIV Medicine, 2013
http://www.ncbi.nlm.nih.gov/pubmed/22639840

Presentation: Klein MB et al. Mortality in HIV–Hepatitis C virus (HCV) co-infected persons enrolled in the Canadian Co-infection Cohort study in comparison to the Canadian population, 2012
http://www.cocostudy.ca/publications/mortality-in-HIV-hepatitis-c-virus-HCV-co-infected-persons-enrolled-in-the-canadian-Co-infection–Cohort-study-in-comparison-to-the-canadian-population/