Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV‐infected patients

Bedimo, Roger; Westfall, Andrew O.; Mugavero, Michael J.; Drechsler, Henning; Khanna, N; Saag, Michael S.

doi:10.1111/j.1468-1293.2009.00815.x

Cited by 96 publications

(103 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar results were found when HIVinfected persons were excluded from the analysis [13(10-14) vs. 13 (10)(11)(12)(13)(14)(15), p = 0.659]. The FRS was lower in the HIV and HIV/HCV groups compared with the uninfected and HCVmonoinfected groups (Table 1).…”

supporting

confidence: 75%

“…For the primary comparison of FRS in HCV-infected and HCV-uninfected persons, which included HIV-infected persons, the median FRS (in risk points) was not different between the two groups [13 (interquartile range, IQR 10-14) vs. 13 (10)(11)(12)(13)(14), p = 0.192]. Similar results were found when HIVinfected persons were excluded from the analysis [13(10-14) vs. 13 (10)(11)(12)(13)(14)(15), p = 0.659].…”

mentioning

confidence: 99%

“…4,5 Data from observational studies suggest that chronic HCV infection is independently associated with increased CVD risk [6][7][8][9][10] and thus HCV coinfection may exacerbate CVD risk in HIV-infected persons. 11,12 The Framingham risk score (FRS) is a widely used global risk score for 10-year coronary heart disease (CHD) risk, validated for use in the general, non-HIV-infected population. 13,14 In HIV-infected persons, it has been increasingly recognized that modified risk prediction tools may be needed for optimal CVD risk assessment.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Short Communication: Coronary Heart Disease Risk by Framingham Risk Score in Hepatitis C and HIV/Hepatitis C-Coinfected Persons

Chew

Bhattacharya

McGinnis

et al. 2015

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

We compared the Framingham risk score (FRS) for 10-year coronary heart disease (CHD) risk in age-and race-matched hepatitis C virus (HCV)-infected and HCV-uninfected persons: 114,073 HCV-infected (111,436 HCV-monoinfected and 2,637 HIV/HCV-coinfected) and 122,996 HCV-uninfected (121,380 HIV and HCVuninfected and 1,616 HIV-monoinfected) males without cardiovascular disease, diabetes, or hepatitis B. In unadjusted analyses, FRS was similar between the HCV-infected and HCV-uninfected groups [median (interquartile range, IQR) risk points 13 (10-14) vs. 13 (10-14), p = 0.192]. Cholesterol levels were lower and current smoking more prevalent in the HCV groups (both HCV and HIV/HCV) compared with the uninfected groups ( p < 0.001 for both). Prevalence of non-FRS CHD risk factors, such as substance abuse and chronic kidney disease, in the cohort was high, and differed by HCV and HIV status. Adjusting for age, race/ethnicity, body mass index, chronic kidney disease, drug and alcohol use, and HIV status, HCV infection was associated with minimally lower FRS (b = -0.095 risk points, p < 0.001), suggesting a small but significant difference in 10-year CHD risk estimation in HCV-infected as compared to HCV-uninfected persons when measuring risk by FRS. Given the complex relationship between HCV, HIV, and CHD risk factors, some of which are not captured by the FRS, the FRS may underestimate CHD risk in HCV-monoinfected and HIV/HCV-coinfected persons. HCV-and HIV/HCV-specific risk scores may be needed to optimize CHD risk stratification.

show abstract

supporting

confidence: 75%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Short Communication: Coronary Heart Disease Risk by Framingham Risk Score in Hepatitis C and HIV/Hepatitis C-Coinfected Persons

Chew

Bhattacharya

McGinnis

et al. 2015

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

show abstract

“…Of note, in a large HIV registry, Bedimo et al found that the rate of acute myocardial infarction and cerebrovascular disease were significantly higher among HIV/HCV-coinfected patients than in those with HIV monoinfection (p < 0.001). In the adjusted analysis, HCV coinfection was independently associated with cerebrovascular disease (HR 1.20; 95 % CI 1.04-1.38, p = 0.013), but not with acute myocardial infarction (HR 1.25; 95 % CI 0.98-1.61, p = 0.072) [7].…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing evidence that the achievement of sustained virologic response (SVR) after pegylated interferon (peg-IFN) plus ribavirin (RBV) treatment reduces the incidence of hepatocellular carcinoma (HCC), liver decompensation, and overall mortality in HIV/HCV-coinfected patients [3][4][5][6]. Although HCV coinfection is associated with an increased risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and diabetes mellitus (DM) among HIV-infected patients, the impact of SVR on the risk of the development of extrahepatic complications has been little investigated [7][8][9]. Therefore, we conducted this study to assess the impact of SVR on the incidence of extrahepatic events in a cohort of HIV/HCV-coinfected patients.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Leone

Prosperi

Costarelli

et al. 2016

Eur J Clin Microbiol Infect Dis

View full text Add to dashboard Cite

Data on the effects of sustained virologic response (SVR) to hepatitis C virus (HCV) therapy on the outcome of extrahepatic complications are scarce. We conducted this study to assess the impact of SVR on the occurrence of chronic kidney disease (CKD), diabetes mellitus (DM), and cardiovascular disease (CVD) in a cohort of human immunodeficiency virus (HIV)-infected patients. We analyzed coinfected HIV/HCV patients in the Management of Standardized Evaluation of Retroviral HIV Infection (MASTER) cohort. Only event-free patients with a serum HCV-RNA determination at baseline were included. Patients were divided into four groups: INFexposed with SVR; INF-exposed without SVR; spontaneous HCV clearance; untreated viremic patients. We estimated the incidence of extrahepatic complications and employed Kaplan-Meier curves and Cox regression to assess the association of SVR/INF strata adjusted for a series of confounders. Data from 1676 patients were analyzed (20.29 % started an INF-based regimen). Overall, the incidence of CKD, DM, CVD, and death was 5.32 [95 % confidence interval (CI) 3.99-6.98], 10.13 (95 % CI 8.20-12.37), 6.79 (95 % CI 5.26-8.65), and 13.49 (95 % CI 11.29-16.0) per 1000 person-years of follow-up, respectively. In the Cox model for treated patients, SVR was not associated with a lower risk of CKD, DM, CVD, and death compared to non-SVR. Cirrhosis was significantly associated with a higher risk of CKD [hazard ratio (HR) 2.13; 95 % CI 1.06-4.31], DM (HR 3.48;, and death (HR 6.18;), but not of CVD (HR 1.14; 95 % CI 0.57-2.3). There are still many unknowns regarding the impact of SVR on the occurrence of extrahepatic complications in coinfected HIV/ HCV patients. Further investigations are needed in order to elucidate the role of SVR as an independent prognostic factor for extrahepatic events.

show abstract

Impact of Clinical and Therapeutic Factors on Incident Cardiovascular and Cerebrovascular Events in a Population‐Based Cohort of HIV‐Infected and Non–HIV‐Infected Adults

Tripathi

Liese

Winniford

et al. 2014

Clinical Cardiology

View full text Add to dashboard Cite

Background Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non–acquired immunodeficiency syndrome (AIDS)‐related mortality in the aging human immunodeficiency virus (HIV)‐infected population. The incidence rate and clinical correlates of CVD in people living with HIV/AIDS compared to the general population warrants further investigation. Hypothesis HIV/AIDS is associated with increased risk CVD compared to general population. Methods CVD events in a matched cohort of HIV‐infected and non–HIV‐infected adults, ≥18 years old, served through the South Carolina Medicaid program during 1994 to 2011 were examined using time‐dependent proportional hazards regression and marginal structural modeling. Results A retrospective cohort of 13 632 adults was followed longitudinally for an average of 51 months. The adjusted hazard ratio (aHR) of incident CVD events was higher among HIV‐infected individuals exposed to combination antiretroviral therapy (cART) (aHR = 1.15) compared to the non–HIV‐infected group, but did not differ from the subgroup of cART‐naïve HIV‐infected adults. A higher aHR of incident CVD was associated with comorbid hypertension (aHR = 2.18), diabetes (aHR = 1.38), obesity (aHR = 1.30), tobacco use (aHR = 1.47), and hepatitis C coinfection (aHR = 1.32), and older age (aHR = 1.26), but with a lower risk among females (aHR = 0.86). A higher risk of incident CVD events was also apparent in HIV‐infected individuals with exposure to both protease inhibitors (adjusted risk ratio [aRR] = 1.99) and non‐nucleoside reverse transcriptase inhibitors (aRR = 2.19) compared to those with no exposure. Sustained viral load suppression was associated with a lower risk of incident CVD events (aRR = 0.74). Conclusions After adjusting for traditional risk factors and sociodemographic differences, there is higher risk of incident cardiovascular events among HIV‐infected individuals exposed to combined antiretroviral medications compared to the general population.

show abstract

Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV‐infected patients

Cited by 96 publications

References 38 publications

Short Communication: Coronary Heart Disease Risk by Framingham Risk Score in Hepatitis C and HIV/Hepatitis C-Coinfected Persons

Short Communication: Coronary Heart Disease Risk by Framingham Risk Score in Hepatitis C and HIV/Hepatitis C-Coinfected Persons

Incidence and predictors of cardiovascular disease, chronic kidney disease, and diabetes in HIV/HCV-coinfected patients who achieved sustained virological response

Impact of Clinical and Therapeutic Factors on Incident Cardiovascular and Cerebrovascular Events in a Population‐Based Cohort of HIV‐Infected and Non–HIV‐Infected Adults

Contact Info

Product

Resources

About