HIV, hepatitis C coinfection drives MI risk with increasing age
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People with HIV and untreated hepatitis C virus have an 85% higher risk for type 1 MI per each 10-year increase in age, researchers reported.
In addition, those with HIV without hepatitis C coinfection have a 30% increased risk for MI 10-year increase in age, the researchers wrote.
“HIV and hepatitis C coinfection occurs because they share a transmission route — both viruses may be transmitted through blood-to-blood contact,” Keri N. Althoff, PhD, MPH, associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in a press release. “Due in part to the inflammation from the chronic immune activation of two viral infections, we hypothesized that people with HIV and hepatitis C would have a higher risk of heart attack as they aged compared to those with HIV alone.”
Althoff and colleagues analyzed data from 23,361 people with HIV aged 40 to 79 years who initiated antiretroviral therapy, using data from the North American AIDS Cohort Collaboration on Research and Design from 2000 to 2017. The primary outcome was an adjudicated type 1 MI event; those who initiated direct-acting hepatitis C antivirals were censored at the time of initiation. Researchers calculated crude incidence rates per 1,000 person-years for type 1 MI by calendar time.
Within the cohort, 20% had HCV. The percentage of type 1 MI events was 1.9% and 1.7% for people with HIV with and without HCV coinfection, respectively.
Researchers found that HCV coinfection was not associated with increased type 1 MI risk in people with HIV; however, risk for type 1 MI increased with age and was amplified in those with HCV coinfection, with an adjusted HR per 10-year increase in age of 1.85 (95% CI, 1.38-2.48) compared with those without HCV (adjusted HR per 10-year increase in age, 1.3; 95% CI, 1.13-1.5; P for interaction <. 001).
“People who are living with HIV or hepatitis C should ask their doctor about treatment options for the viruses and other ways to reduce their cardiovascular disease risk,” Raynell Lang, MD, MSc, assistant professor in the department of medicine and community health sciences at the University of Calgary in Alberta, Canada, said in the release. “Several mechanisms may be involved in the increased heart attack risk among coinfected patients. One contributing factor may be the inflammation associated with having two chronic viral infections. There also may be differences in risk factors for cardiovascular disease and nonmedical factors that influence health among people with HIV and hepatitis C that plays a role in the increased risk.”
In the release, Lang noted that effective and well-tolerated hepatitis C therapy was not available during several years of the study period; researchers could not evaluate the association of treated hepatitis C infection on CV risk among people with HIV.
“This will be an important question to answer in future studies,” Lang said.
As Healio previously reported, MI risk has increased in recent years among people with HIV in the United States. Data presented at the Conference on Retroviruses and Opportunistic Infections in February show CVD remains the leading cause of morbidity and mortality in the U.S. and the risk is 40% to 80% higher in HIV patients.
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