Grant: Travel Awards - Institute Community Support

Chronic hepatitis C virus (HCV) infection is an important comorbid condition that affects as many as 1 in 3 people living with HIV. If left untreated, chronic HCV can increase the risk of serious liver diseases, including cirrhosis and liver cancer. Among people living with HIV, liver disease progression happens faster, so treatment of HCV has become a priority to both reduce the risk of death and improve quality of life. New treatments for HCV, which are known as direct-acting antivirals (DAAs), have been available since November 2013 and have replaced longer and less well-tolerated courses of treatment. Results from clinical trials have shown these new medications to be have > 90% effectiveness at providing HCV cure, but trial populations are often highly-selected and do not reflect the patient population currently in care, particularly if they are also HIV-infected. This research project uses data from the CIHR and Canadian HIV Trials Network (CTN)-funded Canadian Co-Infection Cohort to examine the real-world effectiveness of DAAs and predictors for non-adherence and treatment failure among HCV-HIV co-infected Canadians accessing clinical care. There is an important gap in the literature concerning the effectiveness of DAAs in traditionally hard-to-treat populations, including those living with HIV, and it is unclear how patient-centered barriers to care, such as active injection drug use and food insecurity, which are common in co-infected patients, influence adherence and ultimately the likelihood of being cured from HCV. If DAAs are to have an impact on the population-level prevalence of HCV, then, we need a better understanding about its real-world effectiveness in key populations as to be able to prepare interventions that will allow clinicians to target those at greatest risk of being non-adherent and ultimately, failing treatment.