There were high levels of current injecting drug and alcohol use and poverty. Observed event rates [per 100 person-years; 95% confidence interval (CI)] were: significant fibrosis (10.21; 8.49, 12.19), ESLD (3.16; 2.32, 4.20) and death (3.72; 2.86, 4.77). The overall standardized mortality ratio was 17.08 (95% CI 12.83, 21.34); 12.80 (95% CI 9.10, 16.50) for male patients and 28.74 (95% CI 14.66, 42.83) for female patients. The primary causes of death were ESLD (29%) and overdose (24%). We observed excessive morbidity and mortality in learn more this HIV/HCV-coinfected population in care. Over 50% of observed deaths may have been preventable. Interventions

aimed at improving social circumstances, reducing harm from drug and alcohol use and increasing the delivery of HCV treatment in particular will be necessary to reduce adverse health outcomes among HIV/HCV-coinfected persons.

In developed countries such as Canada, HIV infection has evolved from a uniformly deadly disease to become chronic and manageable as a result of effective antiretroviral therapies (ARTs) [1, 2]. As fewer patients experience HIV-related morbidity and mortality, comorbidities and their HSP cancer associated consequences have consequently emerged as primary health concerns and are increasingly driving healthcare utilization and costs [3, 4]. Coinfection with hepatitis C virus (HCV) is among the most important of these comorbidities. As a consequence of shared routes of transmission, over 30% of HIV-infected individuals are coinfected with HCV, with approximately 10 million dually infected [5] world-wide and an estimated 13 000–15 000 dually infected of the 65 000 HIV-infected persons in Canada [6]. The natural course of HCV infection

is accelerated in HIV-coinfected individuals, with Bumetanide faster progression of liver fibrosis leading to a higher risk of cirrhosis, endstage liver diseases (ESLDs), and hepatocellular carcinoma [7, 8]. Despite the potential burden of this important comorbidity, very few data exist on the health status of Canadians coinfected with HIV and HCV, disease progression rates, and the factors that are associated with adverse outcomes in this population. Indeed, good estimates of liver disease progression rates among coinfected persons in general are lacking in the recent ART era. The Canadian Co-infection Cohort Study (CCC) was established to determine the effect of ART and HCV treatment on the progression to ESLD in HCV/HIV-coinfected individuals. The cohort provides a unique opportunity to evaluate the health status of coinfected patients receiving care and to assess regional variations in sociodemographic and clinical characteristics, as well as to document health outcomes in this population.