Hepatitis C virus coinfection independently increases the risk of cardiovascular disease in HIV ‐positive patients

Summary 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.