Co-Infected HIV, Hepatitis C Patients May Have Increased Risk of Heart Attack

Antiretroviral therapies (ART) have increased the lifespan of patients with HIV since the late 1990s. However, HIV patients’ risk of heart attack is 50% more than the risk among patients without HIV. New research suggests that aging patients with HIV who also have untreated hepatitis C virus (HCV) are at an even greater risk of heart attack.

“Due in part to the inflammation from the chronic immune activation of two viral infections, we hypothesized that people with HIV and hepatitis C would have a higher risk of heart attack as they aged compared to those with HIV alone,” said senior study author Keri N. Althoff, PhD, MPH, associate professor in the department of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

According to the 2019 American Heart Association’s Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV, the majority of patients with HIV are 45 years of age and up. With a median follow up of about 4 years, the researchers set out to compare the rate of heart attacks between HIV-only patients and HIV-HCV patients by decade.

The research team gathered health information on patients with HIV who were a part of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) between 2000 and 2017. Among their sample of 23,361 patients who were aged 40 to 79 years, all patients received ART and approximately 20% of patients with HIV also had HCV.

The researchers observed that an HIV patient’s risk of heart attack increases 30% with each passing decade, which increased to 85% if the patient was also positive for HCV. Further, the team identified high blood pressure, smoking, and type 2 diabetes as conditions that could increase the risk of heart attack by 46% to 90%.

Investigators observed that participants on antiretroviral therapies—such as protease inhibitors—had a 45% increased risk. Further, they found that the risk of heart attack was 46% among participants with worse immune function due to low CD4 immune cell levels.

Inflammation that is associated with HIV and HCV may be a contributing factor to an increased risk of heart attack among this population, lead study author Raynell Lang, MD, MSc, an assistant professor in the department of medicine and community health sciences at the University of Calgary in Alberta, said in a press release.

“There also may be differences in risk factors for cardiovascular disease and non-medical factors that influence health among people with HIV and hepatitis C that plays a role in the increased risk,” Lang said.

A lack of research on additional heart attack risk factors limits the results of the study, as does the generalization of risk factors for patients outside the United States. Currently, there are also advanced HCV treatments that could not be accounted for.

“Our findings suggest that HIV and hepatitis C co-infections need more research, which may inform future treatment guidelines and standards of care,” Althoff said in the press release.

Reference

American Heart Association. Heart attack risk increased among people with HIV and hepatitis C as they aged. EurekAlert! September 21, 2022. Accessed on September 21, 2022. https://www.eurekalert.org/news-releases/964929