Effect of depressive symptoms on health services utilization in the HIV and hepatitis C co-infected population in Canada.

Depression is common among people living with HCV and HIV, which contributes to health services utilization (HSU). It is unknown whether successful HCV treatment affects this. We examined depressive symptoms and HSU in people co-infected with HIV-HCV and their association with sustained virologic response (SVR) during the direct-acting antiviral era. We predicted depressive symptoms by a random forest classifier in the Canadian Co-infection Cohort. HSU was measured by inpatient and out-patient visits in the previous six months. We fit zero-inflated negative binomial models. Of the 1153 HCV RNA+participants, 530 were treated and of them, 95% achieved SVR. Without SVR, inpatient and out-patient visits were 17% and 5% higher among those with depressive symptoms than those without respectively; with SVR, this association disappeared. SVR was associated with 24% fewer inpatient visits. Thus, depressive symptoms were associated with a modest increase in HSU, and SVR appears to attenuate this effect.