Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus

Abstract

Background An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. Methods HIV–HCV coinfected patients were enrolled in the ANRS CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. Results At baseline, median age of the study population (n=1213) was 45.4 (interquartile range [IQR] 42.1−49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9−7.0) years, the incidence was 6.98 (95% confidence interval [CI] 5.19−9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78−6.00) for coronary and/or cerebral events, and 3.17 (2.05−4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06, 95% CI 1.01−1.12), prior CVD (HR 8.48, 95% CI 3.14−22.91), high total cholesterol (HR 1.43, 95% CI 1.11−1.83), high-density lipoprotein cholesterol (HR 0.22, 95% CI 0.08−0.63), statin use (HR 3.31, 95% CI 1.31−8.38), and high alcohol intake (HR 3.18, 95% CI 1.35−7.52) were independently associated with total ASCVD events, while undetectable baseline viral load (HR 0.41, 95%CI 0.18−0.96) with coronary and/or cerebral events. Conclusion HIV–HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV viral load are essential to control cardiovascular risk.

Risk of severe clinical events after sustained virological response following direct‐acting antiviral therapy in HIV and hepatitis C virus coinfected participants

“…In this study we identified total cholesterol > 5.0 mmol/L as the only factor associated with an increased risk of ischaemic events. High total cholesterol has been identified as a risk factor for ischaemic events in HCV‐infected participants [37,38]. Previous studies also identified LDL cholesterol as a factor associated with the risk of ischaemic events [37,38].…”

“…High total cholesterol has been identified as a risk factor for ischaemic events in HCV-infected participants [37,38]. Previous studies also identified LDL cholesterol as a factor associated with the risk of ischaemic events [37,38]. Participants with LDL cholesterol > 1.4 mmol/L had increased incidence rates [9.1 (4.9-16.9)] compared with participants with lower values [1.9 (0.3-13.2)].…”

Influence of Statin Therapy on the Incidence of Cardiovascular Events, Cancer, and All-Cause Mortality in People Living With HIV: A Meta-Analysis

“…It was shown that a total of 5,320 studies were obtained after literature search in the Medline, the Embase, and the Web of Science databases after excluding of the duplicated records, while 504 of them were excluded based on the titles and abstracts primarily because they were irrelevant studies. Then, 16 of the 28 potentially relevant studies were further excluded based on full-text review according to the reasons listed in Figure 1 and the other 12 studies were finally included (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…However, studies evaluating the influence of statin therapy on the risk of CV events, cancer, and all-cause mortality in PLWH showed inconsistent results (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Some studies suggested the benefits of statins on the above outcomes (22,25,30,31), while other studies did not suggest any benefits of statins (21,23,24,(26)(27)(28)(29)32). Therefore, we performed a meta-analysis to systematically evaluate the efficacy of statin on the risk of CV events, cancer, and all-cause mortality in PLWH.…”

“…In addition, previous meta-analyses have confirmed the efficacy and safety of statins in improving lipid profile in PLWH ( 19 , 20 ). However, studies evaluating the influence of statin therapy on the risk of CV events, cancer, and all-cause mortality in PLWH showed inconsistent results ( 21 – 32 ). Some studies suggested the benefits of statins on the above outcomes ( 22 , 25 , 30 , 31 ), while other studies did not suggest any benefits of statins ( 21 , 23 , 24 , 26 – 29 , 32 ).…”