Changes in quality of life, healthcare use, and substance use in HIV/hepatitis C coinfected patients after hepatitis C therapy: a prospective cohort study

Figures & data

Figure 1. Study flow of participant selection. HCV: hepatitis C virus; SVR: sustained virologic response.

Table 1. Characteristics of Canadian Coinfection Cohort (CCC) participants overall (at cohort enrollment) and of participants beginning HCV treatment (at their pretreatment visit)

			Treatment outcomes
	All patients with chronic HCV (n = 1145)	Patients treated during follow-up (n = 223)	SVR (n = 86)	No SVR (n = 68)	Still on treatment (n = 30)	Unknown (n = 39)
Age (years)	45 (39, 50)	47 (46, 49)	46 (39, 51)	48 (44, 52)	52 (45, 57)	51 (40, 53)
Female	290 (25)	38 (17)	15 (17)	11 (16)	5 (17)	7 (18)
Aboriginal ethnicity	169 (15)	17 (8)	7 (8)	5 (7)	3 (10)	2 (5)
Married/common law	206 (18)	43 (20)	14 (16)	13 (19)	10 (34)	6 (16)
Living situation
Fixed address	989 (86)	202 (51)	73 (85)	62 (91)	30 (100)	37 (95)
Live in shelter	91 (8)	18 (8)	11 (13)	5 (7)	0	2 (5)
Homeless	51 (5)	1 (0.5)	0	1 (1)	0	0
High school graduate	313 (27)	64 (29)	24 (28)	16 (24)	9 (30)	15 (38)
Unemployed	879 (77)	165 (74)	59 (69)	51 (74)	23 (77)	32 (82)
For health reasons	702 (61)	134 (60)	49 (57)	44 (65)	18 (60)	23 (59)
For lifestyle reasons	84 (7)	5 (2)	1 (1)	1 (1)	12 (7)	1 (3)
But able to work	54 (5)	12 (5)	5 (6)	2 (3)	0	5 (13)
Monthly income ≤ $1500 CAD	872 (76)	155 (71)	58 (69)	55 (81)	20 (69)	28 (72)
Men who have sex with men	325 (28)	78 (35)	36 (42)	15 (22)	10 (33)	17 (44)
Risk factors for HCV acquisition
Injection drug use	634 (55)	121 (54)	48 (56)	40 (59)	15 (50)	18 (46)
Blood transfusion	75 (7)	12 (5)	4 (5)	3 (4)	3 (10)	2 (5)
Sex	177 (15)	37 (17)	12 (14)	9 (13)	6 (20)	10 (26)
Other	59 (5)	19 (9)	9 (10)	7 (10)	1 (3)	2 (5)
Unknown	174 (15)	30 (13)	11 (13)	8 (12)	4(13)	7 (18)
Ever injected drugs	919 (80)	170 (76)	66 (77)	55 (81)	20 (67)	29 (74)
Current substance use
Alcohol	608 (53)	92 (41)	35 (41)	31 (46)	12 (40)	14 (36)
Tobacco smoking	868 (76)	140 (63)	58 (67)	44 (65)	19 (63)	19 (49)
Marijuana	617 (54)	98 (44)	39 (45)	29 (43)	13 (43)	17 (44)
Cocaine	767 (67)	24 (11)	9 (10)	10 (15)	2 (7)	3 (8)
Crack	283 (25)	2 (1)	0	2 (3)	0	0
Heroin	443 (39)	9 (4)	2 (2)	4 (6)	2 (7)	1 (3)
HCV genotype 1^1	741 (65)	149 (67)	49 (57)	49 (71)	22 (73)	29 (74)
HCV genotype 2, 3	215 (19)	47 (21)	26 (30)	11 (19)	2 (13)	7 (23)
On ART	939 (82)	202 (91)	75 (87)	60 (88)	30 (100)	37 (95)
HIV RNA < 50 copies/ml	701 (61)	179 (80, 92)	71 (83)	54 (79)	24 (80)	30 (77)
CD4 cell count (cells/μl)	390 (249, 561)	351 (329, 378)	342 (228, 496)	350 (228, 519)	373 (272, 533)	353 (228, 595)
Time from cohort entry to treatment (months)		17 (13, 21)	14 (5, 28)	17 (6, 34)	33 (12, 62)	15 (7, 39)

Data are number (%) for categorical variables, or median (interquartile range) for continuous variables.1: HCV genotype missing in nine participants.ART: antiretroviral therapy; CAD: Canadian dollars; HCV: hepatitis C virus; SVR: sustained virologic response.

Table 2. Incidence rates of health services used (per 100 person-years) among SVR-achievers compared with non-responders

	Before HCV treatment		6 months after HCV treatment
	SVR	No SVR	SVR	No SVR	Adjusted IRR^1
Overall	17.0	13.4	22.0	23.0	0.5 (0.3, 0.9)
Inpatient visits	0.8	1.2	1.3	2.1	0.4 (0.1, 2.1)
Emergency	0.4	0.5	0.3	0.9
Overnight hospital stays	0.4	0.7	1.0	1.2
Outpatient visits	13.7	11.1	9.0	14.3	0.6 (0.3, 1.0)
General practitioner	4.0	3.4	3.0	6.9
HIV clinic^2	6.2	6.2	3.6	4.7
Specialist	3.9	2.3	2.4	2.6
Walk-in visits	2.6	1.1	1.2	0.5	0.6 (0.1, 4.0)

1: Incidence rate ratios (95% confidence intervals) are reported from zero-inflated negative binomial model comparing health service use among SVR-achievers relative to non-responders; adjusted for rates of health service use prior to treatment; 2: HIV clinic visits include medication refills, blood work, nursing, and physician visits, etc.HCV: hepatitis C virus; SVR: sustained virologic response; IRR: incidence rate ratio.

Figure 2. Proportion of patients reporting substance use over time (cohort entry, before treatment, 6 months after treatment, 1 year after treatment) comparing SVR-achievers and non-responders. SVR: sustained virologic response; pre-tx: pretreatment.

Figure 3. Liver fibrosis over time (cohort entry, before treatment, 6 months after treatment, 1 year after treatment) comparing SVR-achievers and non-responders. Aspartate aminotransferase to platelet ratio index (APRI) scores < 0.5 indicate no fibrosis. Aspartate aminotransferase to platelet ratio index scores ≥ 1.5 indicate significant fibrosis. Sustained virologic response was significantly associated with improved APRI scores 6 months and 1 year posttreatment after adjusting for pretreatment APRI scores: linear regression coefficient − 0.7 (95% CI: − 1.1, − 0.3) and ( − 0.6 [95% CI: − 1.1, − 0.1]), respectively. APRI: aspartate aminotransferase to platelet ratio index; SVR: sustained virologic response; Q1: first quartile; Q3: third quartile.