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

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.

Interferon-Free Treatment of Hepatitis C Virus in HIV/Hepatitis C Virus-Coinfected Subjects Results in Increased Serum Low-Density Lipoprotein Concentration

“…15,16,37 The relative impact of the observed increase in LDL concentration associated with HCV clearance, shown here and in other studies, with the decrease observed in other biomarkers of cardiovascular disease observed with HCV clearance on subsequent risk for cardiovascular events requires prospective evaluation. 38 We also demonstrate that an LDL increase occurs with slower kinetics than the decline in HCV viral load in serum during treatment (Fig.…”

“…Whether HCV clearance and changes in LDL will impact the higher rates of cardiovascular events associated with chronic HCV infection, and observed in some studies of HIV/HCV-coinfected relative to HIVmonoinfected subjects, will require prospective study in large patient cohorts. 16,37 In HIV-infected subjects receiving IFNfree treatment for HCV, lipids should be monitored posttreatment for cardiovascular risk assessment and determining indications for lipid-modulating therapy.…”

Effects of Therapy with Maraviroc on the Carotid Intima Media Thickness in HIV-1/HCV Co-infected Patients

“…Several studies demonstrated that inhibition of this co-receptor produces an anti-inflammatory and anti-atherogenic effect (1)(2)(3)(4)(5). A body of evidence has documented that in patients with HIV, atherosclerosis is accelerated and chronic inflammatory processes are activated (6)(7)(8)(9); furthermore, certain evidence indicates that hepatitis C (HCV) co-infection can augment the risk of cardiovascular events (10,11). Moreover, hepatic stellate cells, that play an important role in the pathogenesis of liver fibrosis, express both HIV CCR5 and C-X-C chemokine receptor type 4 (CXCR4) co-receptors.…”

Assessing the Effect of Potential Reductions in Non-Hepatic Mortality on the Estimated Cost-Effectiveness of Hepatitis C Treatment in Early Stages of Liver Disease

“…While this general trend has been well documented, estimating and understanding the exact mechanisms and proportional contributions of these varied, potential causes of mortality among HCV-infected individuals remains more elusive [23]. HCV infection has been linked to a variety of nonhepatic morbidities, including Hodgkin’s lymphoma [24], gestational diabetes [25], cardiovascular disease [19, 26], non-liver cancers [27], renal disease, and stroke [28]. Many studies of non-hepatic disease burden among people with HCV infection also tend to focus on particular groups, such as HIV and HCV co-infected patients [29, 30], diabetics [31], and blood donors [32].…”