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HCV co-infection and risk of acute myocardial and cerebrovascular disease among HIV-infected patients in the pre-HAART and HAART eras
Presented by Roger Bedimo, United States.
R. Bedimo1, A. Westfall2, M. Mugavero2, H. Drechsler1, N. Khanna3, M. Saag2
1VA North Texas Health Care System, Medicine, Dallas, United States, 2University of Alabama at Birmingham, Medicine, Birmingham, United States, 3University of Texas Southwestern Medical Ctr, Medicine, Dallas, United States
Background: HIV+ patients with Hepatitis C co-infection (HIV/HCV) have been found to have lower rates of lipid abnormalities than those without. It remains unclear whether this affects cardiovascular outcomes. We utilized the Veterans Administration HIV Clinical Case Registry to elucidate the impact of HIV/HCV co-infection on incident cardiovascular disease (CVD) adjusting for traditional cardiac risk factors.
Methods: We used diagnostic codes and HCV antibody tests to identify patients with CVD events and hepatitis C co-infection. We performed logistic regression to predict acute myocardial infarction (AMI) by HCV status in the pre-HAART era (1980-95) and HAART era (1996-2004). In the HAART era only, we performed survival analyses (Cox Proportional Hazard model) to predict incident acute myocardial infarction (AMI) and cerebral vascular disease (CVD), exploring antiretroviral therapy (HAART) as a time-dependent variable.
Results: HCV co-infection was associated with an increased rate of incident AMI and CVD in the pre-HAART era (unadjusted hazard ratios (HR) and CI: 1.425; 1.183 - 1.716 for AMI and HR: 1.388; CI: 1.240 - 1.554 for CVD. In the HAART era, we analyzed 19,424 HIV-infected patients (31.6% of which were HCV co-infected) contributing 76,376 patient-years of follow-up. The event rates, unadjusted and adjusted HR associated with HCV co-infection controlling for diabetes mellitus, hypertension, age and duration of HAART are presented in the following table.
| Events | AMI | CVD | | | HIV | HIV/HCV | HIV | HIV/HCV | | Event Rate/1000 Patient-Years | 3.36 | 4.19 | 11.12 | 12.47 | | Unadjusted Hazard Ratio (95% CI; P value) | 1.246 (0.979 - 1.586; 0.075) | 1.121 (0.976 - 1.288; 0.105) | | Adjusted Hazard Ratio (95% CI; P value) | 1.262 (0.985 - 1.616; 0.066) | 1.186 (1.030 - 1.366; 0.018) |
Conclusions: HCV co-infection was associated with a significantly increased risk of AMI and CVD in the pre-HAART era. This effect appears to decline in the HAART era for AMI, but not for CVD.
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