Within-Host Models of HCV-HIV Coinfection

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Over 180 million people are estimated to be infected with HCV globally, an estimated 4-million of whom are HIV- coinfected. The two pathogens can exacerbate each others’ effects and transmission, and HIV coinfection can hinder HCV treatment success. Similarly, HCV is one of the most important coinfecting pathogens of HIV, particularly in developing world settings and among people who inject drugs (PWID). Exciting breakthroughs are occurring in HCV treatment as new direct-acting antiviral agents such as Sofosbuvir are being found to outperform traditional indirect treatment combination of pegylated interferon and ribavirin, but these new treatments have a high price tag and must be administered cautiously. Understanding the role of HIV coinfection in treatment is particularly pressing.

Along with collaborators Roger Kouyos, Jonathan Dushoff and my PhD adviser Bryan Grenfell, I have created a novel modeling framework for within-host dynamics of HCV-HIV coinfection. Our model is able to replicate empirically observed clinical patient outcomes: spontaneous clearance, clearance with treatment, relapse, and treatment non-response, and show how HIV coinfection can shift a patient between outcomes. Incorporating treatment efficacy, our model sheds light on the tradeoffs involved in choosing between treatment protocols, and how treatment duration and efficacy need to be taken into account carefully in coinfected patients. Understanding treatment impact is particularly important in light of the new efficacious but expensive drugs that are beginning to become available.

Our manuscript is available here.