Association of human immunodeficiency virus and hepatitis C virus infection with long-term outcomes post-ST segment elevation myocardial infarction in a disadvantaged urban community

Abstract

Background: HIV and HCV have been linked to an increased risk of cardiovascular disease (CVD). Their impact on long-term outcomes following ST-segment myocardial infarction (STEMI) has not been previously studied. Methods:We leveraged data from a STEMI registry (n=1208) at an inner-city health system to assess the influence of HIV and HCV on post-STEMI outcomes. Cox regression was used to compare HIV-monoinfected (n=22), HCV-monoinfected (n=26) and HIV-HCV-coinfected patients (n=8) with the neither-infected group (n=1152) with regard to death, death or any readmission, and death or CVD readmission. Results:The cohort was majority black or Hispanic. Median follow-up was 4.3 years. Compared to the neither-infected group, the HIV-monoinfected group showed near-significantly higher risks of death or any readmission (HR=1.62, 95% CI=0.96, 2.74) and death or CVD readmission (HR=1.82, 95% CI=0.98, 3.39) after full adjustment. On similar comparison, the HCVmonoinfected group exhibited significantly higher risks of death (HR=2.09, 95% CI=1.05, 4.15) and death or any readmission (HR=1.68, 95% CI=1.07, 2.65), whereas the HIV-HCV-coinfected group showed higher risk of death (HR=6.51, 95% CI=2.28, 18.61). Conclusions:In this cohort composed mostly of race-ethnic minorities, HIV monoinfection tended to be associated with 1.6-to-1.8-fold higher death or readmission for any cause or CVD over long-term follow-up compared to neither infection, whereas HCV monoinfection was associated with 1.7-to-2.1-fold higher death and death or any readmission, and HIV-HCV coinfection with 6.5-fold higher death. These associations require further study in larger populations, but highlight the importance of identifying and treating HIV and HCV in patients presenting with STEMI.

Clinical Outcomes After Acute Coronary Syndromes or Revascularization Among People Living With HIV

“…Of note, our study found suboptimal statin prescription in patients living with HIV after ACS or revascularization, which is consistent with results of other retrospective studies. 11,18,19,26,28,[38][39][40][41][42] These findings and those of the Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults (REPRIEVE) trial, 14 which demonstrated the benefits of pitavastatin for primary prevention of atherosclerotic cardiovascular disease among patients living with HIV, highlight the need for a concerted effort to improve guideline-directed statin prescription and adherence among these patients. 43 Additionally, the higher prevalence of smoking and higher triglyceride levels we found among patients living with HIV highlight areas for optimization, with the goal of improving secondary prevention of atherosclerotic cardiovascular disease.…”

“…30,31 All were retrospective cohort studies except for 3 prospective studies (Table 1). 11,26,30 Details of patient characteristics and outcomes by study are presented in Table 1 high-density lipoprotein cholesterol (40 [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] vs 46 [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] mg/dL; P = .03) levels. (To convert triglycerides and cholesterol to millimoles per liter, multiply by 0.0113 and 0.0259, respectively.)…”

“…The pooled mean (range) CD4 count was 377 (318-462) cells/mm 3 among patients living with HIV, and most of these patients (pooled proportion [range], 77.8% [63.3%-94.6%]) had a viral load less of than 200 copies per mL (Table 2). Among 13 studies 11,15,16,18,[25][26][27][28][29][31][32][33][34] that reported data on ACS, patients living with HIV and those in control groups presented similarly with ST-segment elevation myocardial infarction, non-STsegment elevation myocardial infarction, and unstable angina. Additionally, the groups received PCIs or coronary artery bypass graft surgery at similar proportions.…”

“…We captured data on race and ethnicity to help assess the full scope of diversity among patients living with HIV and how applicable our data may be within the global population of people living with HIV. Race and ethnicity were self-reported in the study by Shitole et al 18 In the other studies reporting this information, data were obtained from review of medical records, including electronic health records. Reported race and ethnicity categories included African American, American Indian, Asian, Hispanic, Pacific Islander, White, and other.…”

HIV, hepatitis C virus and risk of new-onset left ventricular dysfunction in women

“…We divided the cohort into neither-infected, HCV-monoinfected, HIV-monoinfected and HIV--HCV-coinfected groups, as done elsewhere [30]. We employed relative risk regression using a Poisson working model with a log-link function and robust standard errors to calculate risk ratios of new-onset LV dysfunction with the neither-infected group as referent.…”