Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV-infected patients

R. Bedimo, A. O. Westfall, M. Mugavero, H. Drechsler, N. Khanna, M. Saag

Research output: Contribution to journalArticle

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Abstract

Background:Among HIV-infected patients, hepatitis C virus (HCV) coinfection is associated with lower cholesterol levels, but it remains unclear how it affects cardiovascular outcomes. Methods:We performed logistic regression to evaluate acute myocardial infarction (AMI) and cerebrovascular disease (CVD) events by HCV status among HIV-infected US veterans in the highly active antiretroviral therapy (HAART) era (1996-2004). We then performed survival analyses to evaluate incident AMI and CVD, exploring antiretroviral therapy (ART) as a time-dependent variable. Results:A total of 19 424 HIV-infected patients [31.6% of whom were HCV-coinfected (HIV/HCV)] contributed 76 376 patient-years of follow-up. HCV coinfection was associated with lower rates of hypercholesterolaemia (18.0% in HIV/HCV vs. 30.7% in HIV-only patients; P<0.001), but higher rates of hypertension (43.8%. vs. 35.6%; P<0.0001), type 2 diabetes mellitus (16.2%vs. 11.1%; P<0.0001) and smoking (36.7%vs. 24.7%;P=0.009). Rates of AMI and CVD were significantly higher among HIV/HCV than HIV-only patients: 4.19 vs. 3.36 events/1000 patient-years, respectively (P<0.001), for AMI; and 12.47 vs. 11.12 events/1000 patient-years, respectively (P<0.001), for CVD. When analyses were controlled for diabetes mellitus, hypertension, age and duration of ART, hazard ratios (HRs) among those with HIV/HCV (vs. HIV only) were 1.25 [95% confidence interval (CI) 0.98-1.61; P=0.072] for AMI and 1.20 (CI 1.04-1.38; P=0.013) for CVD. Hypertension (HR 2.05; P<0.001), greater age (HR 1.79; P<0.001) and longer duration (cumulative years) of antiretroviral use (HR 1.12; P=0.0411) were also associated with increased risk of AMI in the adjusted model. Conclusions:In the HAART era, HCV coinfection was associated with a significantly increased risk of CVD and a trend towards an increased risk of AMI among HIV-infected patients. No claim to original US government works.

Original languageEnglish (US)
Pages (from-to)462-468
Number of pages7
JournalHIV Medicine
Volume11
Issue number7
DOIs
StatePublished - Aug 2010

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Coinfection
Hepacivirus
Cardiovascular Diseases
HIV
Cerebrovascular Disorders
Myocardial Infarction
Cardiomyopathies
Highly Active Antiretroviral Therapy
Hypertension
Confidence Intervals
Veterans
Survival Analysis
Hypercholesterolemia
Type 2 Diabetes Mellitus
Diabetes Mellitus
Logistic Models
Smoking
Cholesterol

Keywords

  • Acute myocardial infarction
  • Cerebrovascular disease
  • Hepatitis C
  • Highly active antiretroviral therapy
  • Incidence

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Health Policy

Cite this

Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV-infected patients. / Bedimo, R.; Westfall, A. O.; Mugavero, M.; Drechsler, H.; Khanna, N.; Saag, M.

In: HIV Medicine, Vol. 11, No. 7, 08.2010, p. 462-468.

Research output: Contribution to journalArticle

Bedimo, R. ; Westfall, A. O. ; Mugavero, M. ; Drechsler, H. ; Khanna, N. ; Saag, M. / Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV-infected patients. In: HIV Medicine. 2010 ; Vol. 11, No. 7. pp. 462-468.
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abstract = "Background:Among HIV-infected patients, hepatitis C virus (HCV) coinfection is associated with lower cholesterol levels, but it remains unclear how it affects cardiovascular outcomes. Methods:We performed logistic regression to evaluate acute myocardial infarction (AMI) and cerebrovascular disease (CVD) events by HCV status among HIV-infected US veterans in the highly active antiretroviral therapy (HAART) era (1996-2004). We then performed survival analyses to evaluate incident AMI and CVD, exploring antiretroviral therapy (ART) as a time-dependent variable. Results:A total of 19 424 HIV-infected patients [31.6{\%} of whom were HCV-coinfected (HIV/HCV)] contributed 76 376 patient-years of follow-up. HCV coinfection was associated with lower rates of hypercholesterolaemia (18.0{\%} in HIV/HCV vs. 30.7{\%} in HIV-only patients; P<0.001), but higher rates of hypertension (43.8{\%}. vs. 35.6{\%}; P<0.0001), type 2 diabetes mellitus (16.2{\%}vs. 11.1{\%}; P<0.0001) and smoking (36.7{\%}vs. 24.7{\%};P=0.009). Rates of AMI and CVD were significantly higher among HIV/HCV than HIV-only patients: 4.19 vs. 3.36 events/1000 patient-years, respectively (P<0.001), for AMI; and 12.47 vs. 11.12 events/1000 patient-years, respectively (P<0.001), for CVD. When analyses were controlled for diabetes mellitus, hypertension, age and duration of ART, hazard ratios (HRs) among those with HIV/HCV (vs. HIV only) were 1.25 [95{\%} confidence interval (CI) 0.98-1.61; P=0.072] for AMI and 1.20 (CI 1.04-1.38; P=0.013) for CVD. Hypertension (HR 2.05; P<0.001), greater age (HR 1.79; P<0.001) and longer duration (cumulative years) of antiretroviral use (HR 1.12; P=0.0411) were also associated with increased risk of AMI in the adjusted model. Conclusions:In the HAART era, HCV coinfection was associated with a significantly increased risk of CVD and a trend towards an increased risk of AMI among HIV-infected patients. No claim to original US government works.",
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T1 - Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV-infected patients

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AU - Westfall, A. O.

AU - Mugavero, M.

AU - Drechsler, H.

AU - Khanna, N.

AU - Saag, M.

PY - 2010/8

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N2 - Background:Among HIV-infected patients, hepatitis C virus (HCV) coinfection is associated with lower cholesterol levels, but it remains unclear how it affects cardiovascular outcomes. Methods:We performed logistic regression to evaluate acute myocardial infarction (AMI) and cerebrovascular disease (CVD) events by HCV status among HIV-infected US veterans in the highly active antiretroviral therapy (HAART) era (1996-2004). We then performed survival analyses to evaluate incident AMI and CVD, exploring antiretroviral therapy (ART) as a time-dependent variable. Results:A total of 19 424 HIV-infected patients [31.6% of whom were HCV-coinfected (HIV/HCV)] contributed 76 376 patient-years of follow-up. HCV coinfection was associated with lower rates of hypercholesterolaemia (18.0% in HIV/HCV vs. 30.7% in HIV-only patients; P<0.001), but higher rates of hypertension (43.8%. vs. 35.6%; P<0.0001), type 2 diabetes mellitus (16.2%vs. 11.1%; P<0.0001) and smoking (36.7%vs. 24.7%;P=0.009). Rates of AMI and CVD were significantly higher among HIV/HCV than HIV-only patients: 4.19 vs. 3.36 events/1000 patient-years, respectively (P<0.001), for AMI; and 12.47 vs. 11.12 events/1000 patient-years, respectively (P<0.001), for CVD. When analyses were controlled for diabetes mellitus, hypertension, age and duration of ART, hazard ratios (HRs) among those with HIV/HCV (vs. HIV only) were 1.25 [95% confidence interval (CI) 0.98-1.61; P=0.072] for AMI and 1.20 (CI 1.04-1.38; P=0.013) for CVD. Hypertension (HR 2.05; P<0.001), greater age (HR 1.79; P<0.001) and longer duration (cumulative years) of antiretroviral use (HR 1.12; P=0.0411) were also associated with increased risk of AMI in the adjusted model. Conclusions:In the HAART era, HCV coinfection was associated with a significantly increased risk of CVD and a trend towards an increased risk of AMI among HIV-infected patients. No claim to original US government works.

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KW - Cerebrovascular disease

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KW - Highly active antiretroviral therapy

KW - Incidence

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