HIV and HCV co-infection increases the risk of heart attack with age

People living with HIV face an increasing likelihood of heart attacks as they age, and that risk increases if they also have the hepatitis C virus (HCV), according to a new study published in the Journal of the American Heart Association was published. The good news is that managing traditional cardiovascular risk factors, controlling HIV, and treating hepatitis C can reduce risk.

Because people living with HIV live longer thanks to effective treatment, they are more likely to develop age-related diseases, such as cardiovascular disease (CVD). A wealth of research has shown that HIV-positive people are at higher risk for a variety of cardiovascular problems, including atherosclerosis (buildup of cholesterol and other material in the arteries) and coronary artery disease (blockage of the arteries that supply the heart muscle). ). ), heart failure and heart attack (myocardial infarction).

HIV and the hepatitis C virus share some transmission routes, and many people live with both viruses (known as co-infection). Hepatitis C can now be easily cured with direct-acting antivirals, but a significant proportion of people with HCV are unaware of their status and have not been treated.

Hepatitis C is also associated with cardiovascular problems, but the combined effects of HIV and HCV are not well understood. Keri Althoff, PhD, MPH, of the Johns Hopkins Bloomberg School of Public Health, and colleagues wanted to find out whether HIV/HCV co-infection increases the risk of type 1 myocardial infarction – the type of heart attack caused by coronary artery disease – increased and whether there is a risk differs according to age.

“Partly because of the inflammation from the chronic immune activation of two viral infections, we hypothesized that people living with HIV and hepatitis C would be at higher risk of heart attack with age than people living with HIV alone,” Althoff said in an American press release the heart society.

The researchers analyzed data from 2000 to 2017 from 23,361 HIV-positive North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) participants who had started antiretroviral treatment for HIV. More than 80% were men, about half were white, and they were between the ages of 40 and 79 (median 45) when they enrolled in NA-ACCORD. One in five study participants (4,677) also had hepatitis C. Data from HIV/HCV co-infected participants were no longer included after initiation of hepatitis C treatment.

Over a mean follow-up period of about four years, the researchers compared the incidence of heart attacks in the groups with pure HIV and HIV/HCV co-infection, both overall and by decade of age.

During follow-up, there were 314 type 1 myocardial infarctions in people living with HIV only and 89 in people with HIV/HCV co-infection, accounting for 1.7% and 1.9%, respectively.

Overall, hepatitis C was not significantly associated with a higher risk of heart attack. However, while the risk of type 1 myocardial infarction in people living with HIV alone increased by 30% per decade, it increased by 85% in people living with HIV and HCV.

Looking beyond HCV status, the researchers confirmed that traditional cardiovascular risk factors, including smoking, high blood pressure and type 2 diabetes, were associated with a greater likelihood of myocardial infarction. In addition, HIV-related factors, including a low CD4 count, a history of AIDS-defining diseases, and use of protease inhibitors, have also been associated with a higher risk of heart attack.

“[T]he risks [type 1 myocardial infarction] was greater with increasing age in persons with HCV compared to persons without HCV, and HCV status should be considered when assessing cardiovascular risk in aging people with HIV,” the researchers concluded. “Further understanding of the complex interplay of factors that influence cardiovascular risk in older people living with HIV will improve their long-term care and well-being.”

“Multiple mechanisms may be involved in the increased risk of heart attack in co-infected patients,” said the study’s lead author, Raynell Lang, MD, MSc, of the University of Calgary in Canada. “One contributing factor may be the inflammation associated with two chronic viral infections. There may also be differences in cardiovascular disease risk factors and non-medical factors affecting the health of people living with HIV and hepatitis C that play a role in the increased risk.”

More than half of the people living with HIV in the United States today are aged 50 or older. As people living with HIV age, reducing the risk of cardiovascular disease “is a primary therapeutic goal,” the researchers wrote. People with both HIV and HCV are at higher risk for cardiovascular problems, “underscoring the importance of maintaining antiretroviral therapy, promoting cardiovascular disease risk reduction strategies, and initiating treatment for their HCV to reduce chronic inflammation, which is believed to contribute to this risk.”

Effective and well-tolerated HCV treatment was not available for several years of the study period, so researchers were unable to assess the effect of treated hepatitis C on cardiovascular risk in people living with HIV. Several studies have found that HCV clearance is associated with reduced cardiovascular events, but there is little data in people co-infected with HIV/HCV. “This will be an important question that needs to be answered in future studies,” Lang said.

In addition to HIV and hepatitis C treatment, people who are aging with HIV can take other measures to reduce their risk of heart disease, including stopping smoking, eating a balanced diet, exercising, maintaining a healthy weight, and taking medications such as as statins (currently being studied in the REPRIEVE study). Regular checkups that include monitoring blood pressure, blood sugar, and cholesterol levels can provide warning signs of heart problems at an earlier stage when they are more manageable.

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