Grant: Operating Grant - PA: HIV/AIDS Res Initiative - Hlth Svs/Population Hlth Stream

In Canada, the emergence of hepatitis C virus (HCV) in individuals infected with HIV is an increasingly significant problem. However, the future health and economic burden associated with this population is unknown. Hepatitis C affects approximately one in three of people living with HIV (and approximately one in ten of those infected with hepatitis C are also infected with HIV) in Canada. Injecting drug use is the most common way that people become infected by both HIV and HCV. Other populations that are affected by co-infection with HCV and HIV in Canada include aboriginals and prisoners. Highly active antiretroviral HIV therapy (HAART) does not appear to significantly reduce HCV-related outcomes such as advanced scarring of the liver, liver failure, liver cancer, or other liver-related death. Furthermore, hepatitis C-related advanced scarring of the liver is found to be significantly associated with higher risk of developing AIDS-defining illness (2-3-fold), AIDS-related death, or hospitalization in HIV/HCV co-infected patients than in HIV mono-infected patients. Treatment for chronic HCV infection decrease the risk of these events, in particular, through prevention of progression to advanced scarring of the liver. The advances in HCV therapy and the improved cure rates (sustained virologic response rate of one in two to four treated) and tolerability make treatment a more feasible option for many co-infected patients. Current guidelines recommend that all HIV-infected patients with chronic HCV infection be considered as treatment candidates for HCV therapy. Despite this, very few co-infected individuals receive treatment for HCV, and thus its overall effectiveness on the natural history of HCV disease in these populations has been relatively small. This project aims to use simulation models to evaluate the health impact and cost-effectiveness of hepatitis C treatment strategies on the future burden of disease related to HIV and HCV co-infection in Canada.