Hepatitis C in Patients With HIV Increases Age-Related Cardiovascular Disease Risk

The association between increasing age and risk for type 1 myocardial infarction (MI) in patients with HIV is more significant among those with vs without hepatitis C virus (HCV) coinfection, suggesting that HCV status should be considered when evaluating cardiovascular disease (CVD) risk in this patient population. These study findings were published in The Journal of the American Heart Association. 

Researchers sought to determine whether patients with HIV and HCV coinfection were at increased risk CVD, as well as the influence of age on this risk.

Data for the study were sourced between January 2000 and December 2017 from the North American AIDS Cohort Collaboration on Research and Design. Patients included in the study were aged between 40 and 79 years and had received antiretroviral therapy (ART) for at least the previous 3 months.

The primary outcome was the incidence of type 1 MI between patients with vs without HCV coinfection.

The study population included 23,361 patients, of whom 18,684 (80%) had HIV infection alone and 4677 (20%) had HCV coinfection. Among patients with and without HCV coinfection, 23% and 16% were women, 47% and 30% were non-Hispanic Black, 53% and 7% used injectable drugs, 29% and 26% had a history of AIDS-defining illness, 65% and 56% used protease inhibitors, and 35% and 24% had an unsuppressed HIV viral load (≥200 copies/mL) at baseline, respectively (all P <.001). Patients with vs without HCV coinfection were more likely to be cigarette smokers (76% vs 57%), have alcohol use disorder or dependence (36% vs 16%), and have diabetes (8% vs 7%).

Researchers found that incident type 1 MI occurred among 89 (1.9%) patients with HCV coinfection (incidence rate [IR], 3.99; 95% CI, 3.16-4.82 per 1000 patient-years [py]) and 314 (1.7%) of those with HIV alone (IR, 3.64; 95% CI, 3.24-4.05 per 1000 py).

After adjustments for covariates, an increased risk for type 1 MI was observed for every 10-year increase in age among all patients (adjusted hazard ratio [aHR], 1.38; 95% CI, 1.21-1.57). An increased risk for type 1 MI also was observed among patients with diabetes (aHR, 1.49; 95% CI, 1.16-1.90), those who were smokers (aHR, 1.89; 95% CI, 1.44-2.50), and those who used protease inhibitors (aHR, 1.45; 95% CI, 1.16-1.81). Of note, the risk for type 1 MI was significantly increased among patients with hypertension (aHR, 3.76; 95% CI, 2.94-4.73).

Stratified by HCV status, the association between an increased risk for type 1 MI per 10-year increase in age was significantly increased among patients with HCV coinfection (aHR, 1.85; 95% CI, 1.38-2.48) compared with those with HIV alone (aHR, 1.30; 95% CI, 1.13-1.50; P <.001).

Study limitations included the small number of cases of incident type 1 MI, the small number of patients aged 60 years and older (5%), and the inability to differentiate between active and inactive HCV coinfection.

According to the researchers, “Further understanding of the complex interplay of factors impacting cardiovascular risk as PWH [patients with HIV] age will improve their long-term care and well-being.”