Grant: Doctoral Research Award - PA: Biomedical/Clinical HIV/AIDS Research

In Canada, infection with both HIV and the hepatitis C virus has become an important issue. Since the introduction of HIV treatment, there has been a decrease in mortality from AIDS in HIV-infected people. However, as life expectancies increased, sickness from HCV-associated liver disease has risen and is now one of the leading causes of death in HIV-infected people. The decision to treat a HIV-infected person with medication is currently based on a patient's level of immunity, which is commonly referred to as their CD4+ cell count. For patients who only are infected with HIV, guidelines suggest that they start treatment once their cell count falls below 350 cells. For people who are co-infected, it is unclear about when the best time to start therapy is. It has been hypothesized that starting treatment earlier may delay liver disease and reduce the risk of developing AIDS. To date, there has been no study that has examined the effect of early therapy in HIV-HCV co-infected patients. The primary objective of this study is to determine the effect that starting therapy earlier in co-infected patients has on their survival, the occurrence of AIDS, and their liver disease risk, using data from a large Canadian cohort of co-infected individuals. Our secondary objectives will be to investigate health-care utilization and costs associated with the occurrence of toxic side-effects associated with earlier treatment and to determine the cost-effectiveness of starting HIV therapy earlier. In the absence of randomized trials, results from this study will provide information about when is the optimal time to initiate HIV therapy to reduce morbidity and mortality from liver disease and AIDS. We plan to disseminate the results of the study to stakeholders, such as the Canadian Trials Network, the Canadian AIDS Society and the Canadian AIDS Treatment Information Exchange organization.