Increased prevalence of cardiovascular disease among HIV-positive individuals coinfected with hepatitis C

Matthew Frieberg and colleagues from University of Pittsburgh published results in the 11 January issue of AIDS, from a cross sectional analysis looking at the association between hepatitis C and prevalent cardiovascular disease (CVD) among HIV-positive patients.

Patients were enrolled between August 2001 to July 2003 from the HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) cohort. This is a prospective cohort of HIV-positive individuals with current or past alcohol problems.

They analysed health questionnaire and laboratory data from 400 HIV-positive individuals (50% co-infected with hepatitis C) from the HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) cohort. Five participants were later excluded because of missing hepatitis C RNA data (n = 4) or a history of CVD data (n = 1).

CVD was defined as a yes response to one of the three following questions: Has a doctor ever told you that you had i) peripheral vascular disease (hardening of the arteries in your neck or legs, atherosclerosis); ii) a stroke, cerebrovascular accident, blood clot or bleeding in the brain, or transient ischemic attack; or iii) a heart attack (myocardial infarction)?

Compared with the HIV-monoinfected patients, those with co-infection were older (43.9 versus 40.9 years), had a higher prevalence of ever having had diabetes (10.1 versus 4.1%), cirrhosis (10.6 versus 2.5%), myocardial infarctions (6.5 versus 0.5%), and CVD (11.1 versus 2.5%), and a lower prevalence of hypercholesterolemia (19.7 versus 33.0%); p<0.05 for all.

After adjusting for age, the OR, estimated by logistic regression, for the prevalence of CVD was significantly higher among those with hepatitis C co-infection (adjusted OR 4.65, 95%CI 1.70-12.71), and was maintained when adjusting other sociodemographic characteristics, including substance use, and cardiovascular risk factors in separate regression models. Analyses excluding participants with diabetes yielded similar results.

Although the small number of self-reported cardiovascular events in the monoinfected group limited the ability to adjust for confounders in the multivariable models, the investigators concluded that their data suggest that hepatitis C infection may be associated with an increased risk of CVD among those co-infected with HIV. They cautioned that as all the participants in this cohort had alcohol problems, the findings may not be generalisable to the HIV-positive population without alcohol problems.

Freiberg MS, Cheng DM, Kraemer KL The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals. AIDS: Volume 21(2) 11 January 2007 p 193-197.