Among people with HIV (PWH), coinfection with hepatitis C (HCV) is associated with an 85% increased risk of myocardial infarction (MI) every decade, a new analysis suggests.
In contrast, the risk increases by 30% every 10 years among PWH without HCV infection.
“There is other evidence to suggest that people with HIV and HCV have a higher burden of negative health outcomes,” said lead author Keri N. Althoff, PhD, MPH, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. the heart.org | Medscape Cardiology. “But the magnitude of ‘major’ was greater than I expected.”
“Understanding the difference that HCV can make in the risk of myocardial infarction with increasing age among people with HCV, compared to those without, is an important step in understanding the additional potential benefits of treatment.” of HCV (among PWH),” he said.
Amplified risk with age did occur, although overall the association between HCV coinfection and an increased risk of type 1 myocardial infarction (T1MI) was not significant, the analysis showed.
The study was published online September 21 in the Journal of the American Heart Association.
how age counts
Althoff and colleagues analyzed data from 23,361 PWH aged 40 to 79 years who had started antiretroviral therapy between 2000 and 2017. The primary outcome was T1MI.
A total of 4677 participants (20%) had HCV. 89 T1MIs occurred among PWH with HCV (1.9%) vs. 314 among PWH without HCV (1.7%). In adjusted analyses, HCV was not associated with an increased risk of T1MI (hazard ratio adjusted [aHR]0.98).
However, the risk of T1MI increased with age and was increased in those with HCV (aHR per 10-year increase in age, 1.85) versus those without HCV (aHR, 1.30).
Specifically, compared with people without HCV, the estimated risk of T1MI was 17% higher among people aged 50 to 59 years with HCV and 77% higher among people aged 60 years and older; neither association was statistically significant, although the authors suggest this was probably due to fewer participants in the older age categories.
Even without HCV, the risk of T1MI was increased in participants who had traditional risk factors. The risk was significantly higher among PWH aged 40 to 49 years with diabetes, hypertension, chronic kidney disease, protease inhibitor (PI) use, and smoking, whereas among PWH aged 50 to 59 years, the risk of T1MI was significantly higher among people with hypertension, IP use, and smoking.
Among those older than 60 years, hypertension and low CD4 counts were associated with a significantly increased risk of T1MI.
“Physicians providing medical care to people with HIV need to be aware of their patients’ HCV status,” Althoff said, “and provide support regarding HCV treatment and ways to reduce their cardiovascular risk, including quitting smoking, achieving and maintaining a healthy BMI and treatment for substance use.”
American Heart Association volunteer expert Nieca Goldberg, MD, clinical associate professor of medicine at NYU Grossman School of Medicine in New York City and medical director of Atria NY, said the increased risk of T1MI with coinfection “makes sense” because both HIV and HCV are linked to inflammation.
However, she told him elcorazon.org | Medscape Cardiology“The fact that the authors did not control for other more traditional heart attack risk factors is a limitation. I would like to see a study that takes other risk factors into account to see if HCV is truly additive.”
In the meantime, like Althoff, he said, “doctors should take a careful history that includes chronic infections and traditional cardiac risk factors.”
Additional studies are needed, Althoff agreed. “There are two paths that we are very interested in pursuing. The first is to understand how metabolic risk factors for myocardial infarction change after HCV treatment. We are working on this.”
“Ultimately,” he said, “we want to compare the risk of myocardial infarction in people with HIV who had successful HCV treatment with those who did not have successful HCV treatment.”
In their current study, they had almost two decades of follow-up, he noted. “Although we don’t need to wait that long, we would like to have about a decade of possible follow-up time (since 2016, when sofosbuvir/velpatasvir became available) to have a large enough sample to look at a sufficient number of myocardial infarctions within the first 5 years after successful HCV treatment.
No trading funds or relevant disclosures were reported.
J Am Heart Assoc. Published online on September 21, 2022. Abstract.
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