Final Report: Estimating the Number of Persons co-infected with Hepatitis C Virus and Human Immunodeficiency Virus in Canada

Executive Summary

Since infection with HIV may complicate the management of patients with chronic hepatitis C virus (HCV) infection and vice versa, we wished to quantify and characterize the extent of dual HCV-HCV infection in Canada. In the first stage of the analysis, we estimated the number of persons infected with HIV according to HIV-defined exposure categories and province/region as of December 1999. Using data from published studies and unpublished reports and the results of a consensus among expert consultants, we estimated the expected HCV prevalence among HIV-infected persons in each HIV defined exposure category for each region. Where appropriate, we adjusted for regional differences in HCV prevalence. The prevalence of HCV-HIV infection was then determined by multiplying the number of HIV-infected persons in each category times the HCV prevalence. We also estimated, specifically, the number of HCV-HIV infected Aboriginal persons and persons incarcerated in Canadian prisons. We calculated 95% confidence limits around our estimates using Monte-Carlo simulation.

As of December 1999, an estimated 11,194 persons in Canada were infected with HCV and HIV, with 95% confidence limits of 9,400 and 13,300. 87% of dually infected persons live in Quebec (34%), British Columbia (29%) or Ontario (25%). We estimate that 7,921 injection drug users (IDUs) and 1,648 men who have sex with men and also inject drugs (MSM-IDU) were dually infected, accounting for 71% and 15%, respectively, of dually infected persons in Canada. Finally, we estimated that 1,477 Aboriginal persons and 611 persons incarcerated in federal and provincial prisons had HCV-HIV infection.

Our analysis is subject to uncertainty due mostly to the lack of precise Canadian serologic data on persons with combined infection. Nevertheless, the number of persons in Canada with dual HCV-HIV infection is undoubtedly substantial. The majority of such persons are (IDU) or MSM-IDUs and are concentrated in Quebec, British Columbia and Ontario. It is unknown what proportion of these persons are aware they are infected with both viruses.

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