Grant: Project Grant

In 2015, the wide availability of highly effective direct-acting antivirals (DAAs) ushered in a "treat all" era for hepatitis C virus (HCV). With DAAs came the opportunity to address one of the most significant causes of illness and death in people living with HIV. Curing HCV in all people with HIV coinfection could prevent an epidemic of liver disease and cancer, reduce associated conditions such as diabetes and cardiovascular disease, and improve overall health and well-being. While the end of HCV has been heralded, in reality, realising the potential of DAAs has faced numerous challenges. Treatment access is uneven and people with vulnerabilities (e.g., substance use, mental illness, poverty, stigma) may not be able to consistently remain engaged in care or complete treatment- key steps to ensuring durable cure and maximizing potential health benefits of DAAs. As treatment expands to people who have ongoing infection risks, re-infections may increase. HIV, its therapies, and associated health issues such as fatty liver disease, may worsen liver disease and prevent liver scaring from improving. The epidemic of opioid misuse and overdose means many people may die even though cured. Over the last 15 years, the Canadian Coinfection Cohort has enrolled over 2000 people living with HIV-HCV, drawn from all affected populations across Canada. Our multidisciplinary team, rigorous methods, extensive national and international partnerships and community engagement ensure we will effectively address the key remaining questions: How can we identify and re-engage those who remain to be treated and cured? Who needs to be monitored for re-infection post-cure and with what frequency? Do all co-infected people have improved liver damage and fewer liver complications after cure? How can we maximize the longterm health benefits of DAAs? Our ultimate goal is to use our results to improve care and treatment and to promote health for all people living with HIV and HCV.