title: The risk of incident coronary heart disease among veterans with and without HIV and hepatitis C.
abstract: BACKGROUND
  Whether hepatitis C virus (HCV) confers additional coronary heart disease (CHD) risk among human immunodeficiency virus (HIV) infected individuals is unclear. Without appropriate adjustment for antiretroviral therapy, CD4 count, and HIV-1 RNA and substantially different mortality rates among those with and without HIV and HCV infection, the association between HIV, HCV, and CHD may be obscured.
  
  
  RESULTS
  We analyzed data on 8579 participants (28% HIV+, 9% HIV+HCV+) from the Veterans Aging Cohort Study Virtual Cohort who participated in the 1999 Large Health Study of Veteran Enrollees. We analyzed data collected on HIV and HCV status, risk factors for and the incidence of CHD, and mortality from January 2000 to July 2007. We compared models to assess CHD risk when death was treated as a censoring event and as a competing risk. During the median 7.3 years of follow-up, there were 194 CHD events and 1186 deaths. Compared with HIV-HCV- Veterans, HIV+HCV+ Veterans had a significantly higher risk of CHD regardless of whether death was adjusted for as a censoring event (adjusted hazard ratio, 2.03; 95% confidence interval, 1.28 to 3.21) or a competing risk (adjusted HR, 2.45; 95% confidence interval, 1.83 to 3.27 respectively). Compared with HIV+HCV- Veterans, HIV+HCV+ Veterans also had a significantly higher adjusted risk of CHD regardless of whether death was treated as a censored event (adjusted hazard ratio, 1.93; 95% confidence interval, 1.02 to 3.62) or a competing risk (adjusted hazard ratio, 1.46; 95% confidence interval, 1.03 to 2.07).
  
  
  CONCLUSIONS
  HIV+HCV+ Veterans have an increased risk of CHD compared with HIV+HCV- and HIV-HCV- Veterans.
authors.affiliation: University of Pittsburgh School of Medicine, 230 McKee Place, Pittsburgh, PA 15213, USA. freibergms@upmc.edu
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Freiberg
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: Kathleen
authors.initials: K
authors.lastname: McGinnis
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Goetz
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez Barradas
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: David
authors.initials: D
authors.lastname: Leaf
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Samet
authors.forename: Lewis
authors.initials: L
authors.lastname: Kazis
authors.forename: Kendall
authors.initials: K
authors.lastname: Bryant
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism* / Q000473:pathology; D002452:Cell Count; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012306:Risk; D016019:Survival Analysis; D014728:Veterans