HIV/HCV coinfected individuals have an increased risk of cardiovascular disease

Coinfection with hepatitis C virus increases the risk of cardiovascular disease in HIV-positive individuals, according to an American study published in the January 11^th edition of AIDS. The investigators found that the relationship between hepatitis C infection and an increased risk of cardiovascular diseases, such as hardening of the arteries, stroke and heart attack persisted even when they adjusted for factors including age, gender, race, blood pressure, drug use and smoking.

Numerous studies have found a connection between chronic infections and an increased risk for cardiovascular disease. However, there are conflicting data regarding any such association and infection with hepatitis C.

Heart disease is an increasing concern for people with HIV. Many HIV-positive individuals are benefiting from the prolonged prognosis that antiretroviral therapy makes possible. But this means that some individuals are now living long enough to develop cardiovascular illnesses, and an association has been found between the use of antiretroviral therapy and a long-term risk of increased metabolic disorders and heart disease. In addition, many HIV-positive individuals (as much as 30% in some cohorts) are coinfected with hepatitis C virus. The investigators from the HIV-Live (HIV-Longitudinal Inter-relationships of Viruses and Ethanol) study therefore wished to see if there was any association between coinfection with hepatitis C virus in a prospective cohort of HIV-positive patients with a history of substance abuse.

A total of 395 individuals were included in the investigators’ analysis. Exactly half of the study population was coinfected with hepatitis C.

Patients were asked to complete a questionnaire about their health and specify if they had ever been told by their doctor that they have hardening of the arteries (atherosclerosis); had a stroke; or, had a heart attack. Data were also gathered on the patients’ age, gender, race, current CD4 cell count, weight, adherence to antiretroviral therapy, blood pressure, alcohol consumption, drug use and housing status. Patients were also asked to state if they had diabetes, renal disease, or lipodystrophy.

Coinfected individuals were significantly older than patients who only had HIV (44 versus 41 years), and had a higher prevalence of health complaints including diabetes (10% versus 4%), cirrhosis (10% versus 3%), heart attack (7% versus 1%) and cardiovascular disease (11% versus 3%). All these differences were statistically significant (p

After adjusting their results for age, the association between hepatitis C coinfection and both cardiovascular disease and heart attack persisted (odds ratios: 4.65 and 12.86 respectively). The investigators then looked to see if any possible confounding factors including gender, race, alcohol consumption, current CD4 cell count, antiretroviral therapy, lipodystrophy, or the use of illicit substances such as crack, cocaine or injected drugs affected these results. They write, “when individual cofounders were added separately to the age-adjusted models, the relationship between hepatitis C and cardiovascular disease remained unchanged”.

The investigators acknowledge that their study had limitations, in particular that patients were asked to self-report their health histories. Nevertheless, they conclude, “among HIV-infected individuals, co-infection with hepatitis C may be independently associated with an increased risk of cardiovascular disease.”