Open AccessAssociation Between Chronic Hepatitis C Virus Infection and Myocardial Infarction Among People Living With HIV in the United States
Author(s) -
Jessica Williams-Nguyen,
Stephen E. Hawes,
Robin M. Nance,
Sara Lindström,
Susan R. Heckbert,
H Nina Kim,
William C Mathews,
Edward R. Cachay,
Matt Budoff,
Christopher B. Hurt,
Peter W. Hunt,
Elvin Geng,
Richard D. Moore,
Michael J. Mugavero,
Inga Peter,
Mari M. Kitahata,
Michael S. Saag,
Heidi M. Crane,
Joseph A. Delaney
Publication year - 2019
Publication title -
american journal of epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.33
H-Index - 256
eISSN - 1476-6256
pISSN - 0002-9262
DOI - 10.1093/aje/kwz236
Subject(s) - medicine , hazard ratio , myocardial infarction , hepatitis c , hepatitis c virus , population , cohort study , cohort , confidence interval , immunology , virus , environmental health
Hepatitis C virus (HCV) infection is common among people living with human immunodeficiency virus (PLWH). Extrahepatic manifestations of HCV, including myocardial infarction (MI), are a topic of active research. MI is classified into types, predominantly atheroembolic type 1 MI (T1MI) and supply-demand mismatch type 2 MI (T2MI). We examined the association between HCV and MI among patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, a US multicenter clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Third Universal Definition of Myocardial Infarction. We estimated the association between chronic HCV (RNA+) and time to MI while adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics, and history of injecting drug use. Among 23,407 PLWH aged ≥18 years, there were 336 T1MIs and 330 T2MIs during a median of 4.7 years of follow-up between 1998 and 2016. HCV was associated with a 46% greater risk of T2MI (adjusted hazard ratio (aHR) = 1.46, 95% confidence interval (CI): 1.09, 1.97) but not T1MI (aHR = 0.87, 95% CI: 0.58, 1.29). In an exploratory cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR = 2.01, 95% CI: 1.25, 3.24). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research.