title: Hepatitis C virus coinfection independently increases the risk of cardiovascular disease in HIV-positive patients.
abstract: Patients infected with HIV are at increased risk for cardiovascular disease despite successful antiretroviral therapy. Likewise, chronic hepatitis C virus (HCV) infection is associated with extrahepatic complications, including cardiovascular disease. However the risk of cardiovascular disease has not been formally examined in HIV/HCV-coinfected patients. A retrospective study was carried out to assess the influence of HCV coinfection on the risk of cardiovascular events in a large cohort of HIV-infected patients recruited since year 2004. A composite event of cardiovascular disease was used as an endpoint, including myocardial infarction, angina pectoris, stroke or death due to any of them. A total of 1136 patients (567 HIV-monoinfected, 70 HCV-monoinfected and 499 HIV/HCV-coinfected) were analysed. Mean age was 42.7 years, 79% were males, and 46% were former injection drug users. Over a mean follow-up of 79.4 ± 21 months, 3 patients died due to cardiovascular disease, whereas 29 suffered a first episode of coronary ischaemia or stroke. HIV/HCV-coinfected patients had a greater incidence of cardiovascular disease events and/or death than HIV-monoinfected individuals (4% vs 1.2%, P = 0.004) and HCV-monoinfected persons (4% vs 1.4%, P = 0.5). After adjusting for demographics, virological parameters and classical cardiovascular disease risk factors (smoking, hypertension, diabetes, high LDL cholesterol), both HIV/HCV coinfection (HR 2.91; CI 95%: 1.19-7.12; P = 0.02) and hypertension (HR 3.65; CI 95%: 1.34-9.94; P = 0.01) were independently associated with cardiovascular disease events and/or death in HIV-infected patients. Chronic hepatitis C and hypertension are independently associated with increased cardiovascular disease risk in HIV-infected patients. Therefore, treatment of chronic hepatitis C should be prioritized in HIV/HCV-coinfected patients regardless of any liver fibrosis staging.
authors.affiliation: Department of Infectious Diseases, Crosshouse University Hospital, Kilmarnock, UK.
authors.forename: J V
authors.initials: JV
authors.lastname: Fernández-Montero
authors.affiliation: Infectious Diseases Unit, La Paz University Hospital, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Barreiro
authors.affiliation: Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: de Mendoza
authors.affiliation: Department of Internal Medicine, La Luz Clinic, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Labarga
authors.affiliation: Infectious Diseases Unit, La Paz University Hospital, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Soriano
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000821:virology; D060085:Coinfection / Q000473:pathology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000473:pathology* / Q000821:virology; D015497:HIV-1; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: HIV; antiretroviral therapy; cardiovascular disease; coinfection; hepatitis C