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Hepatitis C virus coinfection independently increases the risk of cardiovascular disease in HIV ‐positive patients
Author(s) -
FernándezMontero J. V.,
Barreiro P.,
Mendoza C.,
Labarga P.,
Soriano V.
Publication year - 2016
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12447
Subject(s) - medicine , coinfection , hepatitis c , angina , hepatitis c virus , stroke (engine) , myocardial infarction , disease , diabetes mellitus , coronary artery disease , dyslipidemia , cohort , human immunodeficiency virus (hiv) , immunology , virus , endocrinology , mechanical engineering , engineering
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.