Research Papers

@article{Young2023,
title = {The rate of hepatitis C reinfection in Canadians coinfected with HIV and its implications for national elimination},
author = {Jim Young, Shouao Wang, Charlotte Lanièce Delaunay, Curtis L Cooper, Joseph Cox, M John Gill, Mark Hull, Sharon Walmsley, Alexander Wong , Marina B Klein; Canadian Coinfection Cohort Investigators},
doi = {10.1016/j.drugpo.2023.103981},
year = {2023},
date = {2023-04-01},
journal = {Int J Drug Policy },
volume = {114},
number = {103981},
pages = {103981},
abstract = {Background: The World Health Organisation (WHO) has set targets for the rate of new infections as a way to measure progress towards the elimination of hepatitis C virus (HCV) as a public health threat. As more people are successfully treated for HCV, a higher proportion of new infections will be reinfections. We consider whether the reinfection rate has changed since the interferon era and what we can infer about national elimination efforts from the current reinfection rate.

Methods: The Canadian Coinfection Cohort is representative of HIV HCV coinfected people in clinical care. We selected cohort participants successfully treated for a primary HCV infection either in the interferon era or in the era of direct acting antivirals (DAAs). Selected participants were followed from 12 weeks after completing a successful treatment until the end of 2019 or until their last measured HCV RNA. We estimated the reinfection rate in each treatment era, overall and in participant subgroups, using proportional hazard models appropriate for interval censored data.

Results: Among 814 successfully treated participants with additional HCV RNA measurements, there were 62 reinfections. The overall reinfection rate was 2.6 (95% confidence interval, CI, 1.2-4.1) /100 person years (PY) in the interferon era and 3.4 (95% CI 2.5-4.4) /100 PY in the DAA era. The rate in those reporting injection drug use (IDU) was much higher: 4.7 (95% CI 1.4-7.9) /100 PY and 7.6 (95% CI 5.3-10) /100 PY in the interferon and DAA eras respectively.

Conclusion: The overall reinfection rate in our cohort is now above the WHO target set for new infections in people who inject drugs. The reinfection rate in those reporting IDU has increased since the interferon era. This suggests Canada is not on track to achieve HCV elimination by 2030.},
keywords = {HCV Elimination, HCV elimination; HCV reinfection; HCV treatment; HIV-HCV coinfection; People who inject drugs, HCV reinfection, HCV treatment, HIV-HCV coinfection, People who inject drugs},
pubstate = {published},
tppubtype = {article}
}

@article{C2022,
title = {Gaps in hepatitis C virus prevention and care for HIV-hepatitis C virus co-infected people who inject drugs in Canada},
author = {C, Laniece Delaunay; M, Maheu-Giroux; G, Marathe; S, Saeed S; V, Martel-Laferriere; C, Cooper; S, Walmsley; J, Cox; A, Wong A; MB, Klein; },
url = {https://www.sciencedirect.com/science/article/pii/S0955395922000470?via%3Dihub},
doi = {10.1016/j.drugpo.2022.103627},
year = {2022},
date = {2022-02-01},
journal = {International Journal of Drug Policy},
abstract = {Background: People who inject drugs (PWID) living with HIV are a priority population for eliminating hepatitis C virus (HCV) as a public health threat. Maximizing access to HCV prevention and treatment strategies are key steps towards elimination. We aimed to evaluate engagement in harm reduction programs and HCV treatment, and to describe injection practices among HIV-HCV co-infected PWID in Canada from 2003 to 2019.

Methods: We included Canadian Coinfection Cohort study participants who reported injecting drugs between 2003 and 2019 in Quebec, Ontario, Saskatchewan, and British Columbia, Canada. We investigated temporal trends in HCV treatment uptake, efficacy, and effectiveness; injection practices; and engagement in harm reduction programs in three time periods based on HCV treatment availability: 1) interferon/ribavirin (2003-2010); 2) first-generation direct acting antivirals (DAAs) (2011-2013); 3) second-generation DAAs (2014-2019). Harm reduction services assessed included needle and syringe programs (NSP), opioid agonist therapy (OAT), and supervised injection sites (SIS).

Results: Median age of participants (N = 1,077) at cohort entry was 44 years; 69% were males. Province-specific HCV treatment rates increased among HCV RNA-positive PWID, reaching 16 to 31 per 100 person-years in 2014-2019. Treatment efficacy improved from a 50 to 70% range in 2003-2010 to >90% across provinces in 2014-2019. Drug injecting patterns among active PWID varied by province, with an overall decrease in cocaine injection frequency and increasing opioid injections. In the most recent time period (2014-2019), needle/syringe sharing was reported at 8-22% of visits. Gaps remained in engagement in harm reduction programs: NSP use decreased (58-70% of visits), OAT engagement among opioid users was low (8-26% of visits), and participants rarely used SIS (1-15% of visits).

Conclusion: HCV treatment uptake and outcomes have improved among HIV-HCV coinfected PWID. Yet, this population remains exposed to drug-related harms, highlighting the need to tie HCV elimination strategies with enhanced harm reduction programs to improve overall health for this population.},
keywords = {drug injecting patterns, harm reduction, HCV Elimination, HCV treatment, HIV-HCV coinfection, People who inject drugs},
pubstate = {published},
tppubtype = {article}
}

@article{N2021,
title = {Liver Fibrosis in Human Immunodeficiency Virus (HIV)-Hepatitis C Virus (HCV) Coinfection Before and After Sustained Virologic Response: What Is the Best Noninvasive Marker for Monitoring Regression?},
author = {N, Kronfli; J, Young; S, Wang; J, Cox; S, Walmsley; M, Hull; C, Cooper; V, Martel-Laferriere; A, Wong; N, Pick; MB, Klein; Canadian Coinfection Cohort Study Investigators.},
url = {https://academic.oup.com/cid/article/73/3/468/5854053?login=false},
doi = {10.1093/cid/ciaa702},
year = {2021},
date = {2021-08-02},
journal = {Clinical Infectious Diseases},
abstract = {Background: Noninvasive markers of liver fibrosis such as aspartate aminotransferase-to-platelet ratio (APRI) and transient elastography (TE) have largely replaced liver biopsy for staging hepatitis C virus (HCV). As there is little longitudinal data, we compared changes in these markers before and after sustained virologic response (SVR) in human immunodeficiency virus (HIV)-HCV coinfected patients.

Methods: Participants from the Canadian Coinfection Cohort study who achieved SVR after a first treatment with either interferon/ribavirin or direct acting antivirals (DAAs), with at least 1 pre- and posttreatment fibrosis measure were selected. Changes in APRI or TE (DAA era only) were modeled using a generalized additive mixed model, assuming a gamma distribution and adjusting for sex, age at HCV acquisition, duration of HCV infection, and time-dependent body mass index, binge drinking, and detectable HIV RNA.

Results: Of 1981 patients, 151 achieved SVR with interferon and 553 with DAAs; 94 and 382 met inclusion criteria, respectively. In the DAA era, APRI increased (0.03 units/year; 95% credible interval (CrI): -.05, .12) before, declined dramatically during, and then changed minimally (-0.03 units/year; 95% CrI: -.06, .01) after treatment. TE values, however, increased (0.74 kPa/year; 95% CrI: .36, 1.14) before treatment, changed little by the end of treatment, and then declined (-0.55 kPa/year; 95% CrI: -.80, -.31) after SVR.

Conclusions: TE should be the preferred noninvasive tool for monitoring fibrosis regression following cure. Future studies should assess the risk of liver-related outcomes such as hepatocellular carcinoma according to trajectories of fibrosis regression measured using TE to determine if and when it will become safe to discontinue screening.},
keywords = {APRI, Fibrosis regression, HIV-HCV coinfection, Sustained virologic response, Transient elastography},
pubstate = {published},
tppubtype = {article}
}