HIV / HCV Scoping Review
A scoping review of co-infection materials (both published and grey literature) was also conducted to further understand what the co-infection environment looks like. Scoping reviews aim to identify and examine the extent, range and nature of research activity around any given topic, and help to summarize and disseminate research findings, as well as identify any research gaps in the existing literature. The objectives of this review were to identify and share the existing knowledge and action on treatment, care and support services for people living with HIV/HCV co-infections; and to describe the findings and range of research, existing programs and policy implications in the area of co-infection. The broad initial question that guided this review was:
“What is known from the existing literature, practices and policy documents on the treatment, care and support for people living with HIV and Hepatitis C Co infection?”
The article entitled Treatment, care and support for people co-infected with HIV and hepatitis C: A scoping review is now published in Open Medicine (an open access journal).
Reference lists for the above article:
Treatment
- Treatment of HCV in HIV/HCV co-infected patients is well defined internationally
- Canadian treatment guidelines match the international guidelines with newly updated guidelines being published this year by the Canadian Association for the Study of the Liver.
Epidemiology
International:
- Estimates of co-infection rates among people living with HIV/AIDS (not stratified based on risk category) range from 16% - 37%. (Amin J, et al, 2004; Tedaldi, EM, et al, 20003; Wber, R et al, 2006; Backus LI, et al, 2005)
Canada:
- 1999: an estimated 11,194 persons in Canada are infected with HIV and HCV (Remis RS, 2001)
- 1999: an estimated 7,921 IDUs, 1,477 Aboriginal persons and 611 persons incarcerated in federal and provincial prisons are co-infected with HIV-HCV. (Remis RS, 2001)
- 1999: an estimated 87% of co-infected persons live in Quebec (34%), British Columbia (29%), or Ontario (25%) (Remis RS, 2001)
Vulnerability and Risk Factors:
- IDUs account for 71% co-infection (Remis RS, 2001)
- Serious Mental Illness is a major factor in co-infection [HIV (8x) and HCV (11x)] (Goldberg RW et al, 2005; Davidson S et al, 2001; Rosenberg S et al, 2004; Stringari-MurrayS, et al, 2003;Bruneet MF et al, 200
- Aboriginals are at higher risk of co-infection (Miller CL, et al, 2006)
Discussion
- There is no consensus as to whether HIV co-infection should be part of a broader HCV strategy, visa versa, or if co-infection should have its own strategy.
- Current federal and provincial funding streams for HIV and HCV are not integrated and as such, coordinated interventions for co-infection are limited.
- The federal Hepatitis C Prevention, Support & Research Program is funded on an annual basis and a long-term HCV prevention and support strategy has yet to be developed.
- Access to HCV drug coverage varies by province, clinic and physician.
- There is a shortage of formally trained co-infection specialists.
- There are is no universal standards of co-infection practice available for physicians.
Recommendations
- Integration of HIV and HCV in policy and programming at the federal and provincial levels is required.
- An interdisciplinary, integrated approach to care and support is needed.
- Care must be made available to all co-infected people regardless of factors such as geography, poverty or substance use.
- Integration of Public Health and Corrections Services with emphasis on harm reduction strategies (including provision harm reduction services and equipment).
- The development of a research agenda focused on optimal use of currently available treatments and development of new medications is needed.