HCV Raises Risk of Stroke, Maybe MI, in HIV-Positive US Veterans

Author: Mark Mascolini

12 July 2010

In US veterans with HIV, hepatitis C virus (HCV) coinfection independently raised the risk of cerebrovascular disease (such as stroke) and marginally upped the risk of acute myocardial infarction (MI). Because the veterans population is largely male and has free access to care, it is unclear how closely the findings apply to other HIV-positive populations.

HCV is associated with lower cholesterol levels, but how HCV infection affects risk of MI and cerebrovascular disease in people with HIV had not been well studied. This analysis involved 19,424 HIV-positive veterans, 6183 of them (31.6%) with HCV infection. The study focused on veterans cared for during the earlier part of the current antiretroviral era: 1996 to 2004.

Compared with veterans infected only with HIV, those also infected with HCV were significantly less likely to have high cholesterol (18.0% versus 30.7%, P < 0.001). But HCV-coinfected veterans were more likely to have hypertension (43.8% versus 35.6%, P < 0.001), more likely to have type 2 diabetes mellitus (16.2% versus 11.1%, P < 0.0001), and more likely to smoke (36.7% versus 24.7%, P = 0.009).

In analyses not adjusted for other risk factors, rates of acute MI and cerebrovascular disease were significantly higher in HCV-coinfected veterans than in veterans without HCV: 4.19 versus 3.36 events per 1000 patient-years for acute MI (P < 0.001) and 12.47 versus 11.2 events per 1000 patient-years for cerebrovascular disease (P < 0.001).

A statistical analysis that factored in diabetes, hypertension, age, and duration of antiretroviral therapy determined that cerebrovascular disease was 20% more likely in veterans with HCV than in those without HCV (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.04 to 1.38), and this increased risk was statistically significant (P = 0.013). In this analysis acute MI was 25% more likely in veterans with HCV, but this higher risk fell short of statistical significance (HR 1.25, 95% CI 0.98 to 1.61, P = 0.072).

Acute MI was significantly more likely in veterans with hypertension (HR 2.05, P < 0.001), older age (HR 1.79, P < 0.001), and longer duration of antiretroviral therapy (HR 1.12, P = 0.0411).

Source: R. Bedimo, A.O. Westfall, M. Mugavero, H. Drechsler, N. Khanna, M. Saag. Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV-infected patients. HIV Medicine. 2010; 11: 462-468.

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