Hepatitis C Virus Coinfection Independently Increases the Risk of Cardiovascular Disease in HIV-positive Patients

J. V. Fernández-Montero; P. Barreiro; C. de Mendoza; P. Labarga; V. Soriano

Disclosures

J Viral Hepat. 2016;23(1):47-52. 

In This Article

Abstract and Introduction

Abstract

Patients infected with HIV are at increased risk for cardiovascular disease despite successful antiretroviral therapy. Likewise, chronic hepatitis C virus (HCV) infection is associated with extrahepatic complications, including cardiovascular disease. However the risk of cardiovascular disease has not been formally examined in HIV/HCV-coinfected patients. A retrospective study was carried out to assess the influence of HCV coinfection on the risk of cardiovascular events in a large cohort of HIV-infected patients recruited since year 2004. A composite event of cardiovascular disease was used as an endpoint, including myocardial infarction, angina pectoris, stroke or death due to any of them. A total of 1136 patients (567 HIV-monoinfected, 70 HCV-monoinfected and 499 HIV/HCV-coinfected) were analysed. Mean age was 42.7 years, 79% were males, and 46% were former injection drug users. Over a mean follow-up of 79.4 ± 21 months, 3 patients died due to cardiovascular disease, whereas 29 suffered a first episode of coronary ischaemia or stroke. HIV/HCV-coinfected patients had a greater incidence of cardiovascular disease events and/or death than HIV-monoinfected individuals (4% vs 1.2%, P = 0.004) and HCV-monoinfected persons (4% vs 1.4%, P = 0.5). After adjusting for demographics, virological parameters and classical cardiovascular disease risk factors (smoking, hypertension, diabetes, high LDL cholesterol), both HIV/HCV coinfection (HR 2.91; CI 95%: 1.19–7.12; P = 0.02) and hypertension (HR 3.65; CI 95%: 1.34–9.94; P = 0.01) were independently associated with cardiovascular disease events and/or death in HIV-infected patients. Chronic hepatitis C and hypertension are independently associated with increased cardiovascular disease risk in HIV-infected patients. Therefore, treatment of chronic hepatitis C should be prioritized in HIV/HCV-coinfected patients regardless of any liver fibrosis staging.

Introduction

The widespread use of highly active antiretroviral therapy (HAART) has resulted in a dramatic reduction in incidence and aetiology of illnesses and mortality in HIV-infected individuals.[1] Non-AIDS-related conditions, particularly non-AIDS malignancies, liver disease and cardiovascular disease (CVD) have become the most frequent causes of hospitalization and death in HIV-positive persons living in Western countries.[1] Due to population ageing, this trend may further increase in the near future,[2] even despite being shorter the life expectancy of HIV-positive persons compared to the general population.[3]

Due to shared transmission routes, HIV and hepatitis C virus (HCV) coinfection is common. Globally around 20% of HIV-positive patients have chronic hepatitis C.[4] Besides producing liver disease, chronic HCV infection is associated with several extrahepatic complications,[5,6] including lymphomas[7] and kidney dysfunction.[8] More recently, it has been associated with CVD, including both coronary heart disease[9,10] and stroke.[11,12] Given the persistent inflammatory response generated by chronic viral infections,[13] hypothetically HIV and HCV could act synergistically increasing the risk of CVD in coinfected patients.

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