A Population-Based Study 

Background
The burden of hepatitis C virus (HCV)–related hospitalizations is substantial, particularly among people with HIV and HCV. In Ontario, Canada, use of direct-acting antivirals (DAAs) increased when certain restrictions were lifted in 2017 and new, more versatile medications became available in 2018.

Objective
This study examined the impact of expanded DAA access on HCV-related hospitalizations in people with HIV.

Methods
We conducted a population-based study using administrative databases between April 2003 and December 2022. We examined changes in quarterly HCV-related hospitalization rates in people with HIV following the policy changes and compared predicted rates in the absence of expanded DAA access with observed rates during this period.

Results
We identified 2943 HCV-related hospitalizations among people with HIV during our study period. Rates of HCV-related hospitalizations were substantially higher among people with HIV than individuals without HIV. In the postintervention period, there was an immediate level increase in the rate of HCV-related hospitalizations (rate ratio, 1.23), followed by a decrease in trend (rate ratio, 0.94 per quarter). We estimated that expanding DAA access was associated with 192 fewer hospitalizations in people with HIV between 2019 and 2022.

Conclusion
Policies expanding DAA access have reduced HCV-related hospitalizations in people with HIV. However, rates were higher relative to those in people without HIV. Further research is needed to identify and address disparities in clinical outcomes among people with HIV and HCV.

Date Released: January 13, 2025