Objectives

Since 2016 the primary focus of the cohort has shifted to monitoring the scale up and impacts of direct-acting antiviral (DAA) medications for Hepatitis C (HCV) treatment among co-infected Canadians.

The primary objective of the Canadian Co-infection Cohort is to measure the full impact of DAAs for co-infected patients and amass evidence to change HCV treatment paradigms and influence policy so that access and successful outcomes can be maximized.

 The secondary objectives include:

• • 1. To identify patient, provider, and systemic barriers and facilitators to HCV treatment access.
    2. To determine the best models of care to deliver DAAs and engage policy makers to implement them.
    3. To develop and apply novel methodologic approaches for conducting observational research in vulnerable populations.
    4. To evaluate the real-world efficacy and safety of DAAs and compare specific DAA combinations.
    5. To measure the longer-term impacts of DAAs on liver and non-liver related health outcomes, mortality and costs and determine at which disease stage patients most benefit from receiving therapy.

Prior to 2016, the cohort aimed to investigate means of slowing liver disease progression rates in HIV-HCV co-infection and evaluate the role of HCV treatment in the evolution of liver disease with a particular emphasis on evaluating access to treatment, predictors of response and comparing treatment responders vs. non-responders.

 The objectives were to:

• • 1. Estimate the effect of highly active antiretroviral therapy (HAART) on progression to end-stage liver disease (ESLD).
    2. Identify factors that contribute to liver disease progression in HIV-HCV co-infection.
    3. Adjust rates of ESLD for covariates that may play a role in liver disease progression.
    4. Develop methods for evaluating fibrosis progression rates in co-infection.
    5. Establish a tissue bank of peripheral blood mononuclear cells (PBMC), plasma and liver tissue for additional research questions.