Since 2003, the CCC study led by the RI-MUHC’s Dr. Marina Klein has been working to improve care and outcomes for people living with both HIV and hepatitis C
The journey to build the Canadian Co-infection Cohort (CCC) began in 2003, when Dr. Marina Klein first sought to improve care and health outcomes for people living with both HIV and hepatitis C (HCV). Initially a pilot project in Montreal, by 2006 the CCC had expanded across Canada and is now one of the largest cohorts focused on HIV-HCV co-infection in the world.
What is HIV-HCV co-infection?
Infection with both HIV and HCV is called HIV/HCV coinfection. HCV is one of the primary causes of chronic liver disease, and HCV-related liver injuries progress more rapidly in the presence of HIV infection. HIV-HCV co-infection affects approximately 2.3 million people worldwide and between 14,000 and 21,000 people in Canada.
The goal of the CCC is to evaluate how HCV and HIV and their treatments affect the health of people living with these two infections and to assess how social, behavioural and biologic factors influence treatment access and responses. Although HIV cannot be cured, it can be managed and can reach undetectable levels through antiretroviral therapy. With the introduction of direct acting antivirals (DAAs) in 2015, HCV became the the first chronic viral infection that can be cured. In response, the CCC began monitoring the scale-up and impacts of direct-acting antiviral medications for HCV treatment among co-infected Canadians.
Over the last twenty years, the CCC has recruited 2,140 participants in 18 healthcare institutions from six Canadian provinces to build a participant base that reflects a diverse real-world population.
The CCC’s analyses have shown an increase in the effectiveness of HCV treatment and in the proportion of people who are cured, as well as a reduction in liver-related deaths. They have also shown that curing HCV is associated with improvements in mental health and a reduction in liver fibrosis.
Ongoing challenges
The CCC has documented the positive impact of therapeutic advances for both HCV and HIV, but it has also observed significant barriers. Despite successful scale-up efforts and cure rates, HCV elimination in Canada has slowed down. Today, persons with HCV may face multiple, intersecting health inequities and may be navigating competing priorities such as housing and food insecurity. Stigma, alcohol and drug use, and the impacts of colonization, generational trauma and incarceration remain significant challenges in the elimination of HCV. Achieving sustainable outcomes depends on finding ways to reach people, reduce harms, promote health, and foster a research-community partnership.
“We are very proud to partner with both local and national community organizations such as AIDS Community Care Montreal and the Coalition des organismes communautaires Québécois de lutte contre le sida,” says Dr. Klein, who is the CCC principal investigator and a senior scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the McGill University Health Centre (RI-MUHC). Dr. Klein is also a professor of medicine in the Division of Infectious Diseases and Chronic Viral Illnesses at the McGill University Health Centre and a Canada Research Chair in Clinical and Epidemiologic Studies of Chronic Viral Infections in Vulnerable Populations.
Looking towards the future
The investigators of the CCC now have an interest in the long-term effects of curing HCV, specifically liver health, general health and wellbeing, including chronic conditions such as pain.
Complementary to the work of the CCC, and in collaboration with local researchers and community organizations, Dr. Klein has developed another project called Métropole sans Hép C. The goal is to make Montreal the first city in North America to eliminate HCV. This project will provide a roadmap for Canada, informing how infectious diseases in urban settings are tackled across the nation and, ultimately, around the world.
“As well as offering a treatment approach that is both tailored and time-sensitive, we hope Métropole sans HépC will positively impact the way medical experts interact with stigmatized populations,” says Dr. Klein. “We congratulate everyone involved in the Canadian Co-infection Cohort’s first 20 years of important and impactful work.”
The CCC is grateful for the financial support of the Canadian Institutes of Health Research (CIHR), the Canadian HIV Trials Network, and the Réseau SIDA-MI.
November 1, 2023
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