Co-Infected HIV, Hepatitis C Patients May Have Increased Risk of Heart Attack

Research suggests that an HIV patient’s risk of heart attack increases with every decade, and that risk is almost three times higher in people with HIV who are also positive for hepatitis C.

Antiretroviral therapies (ART) have prolonged the lifespan of patients with HIV since the late 1990s. However, the risk of heart attack in HIV patients is 50% higher than in non-HIV patients. New research suggests that aging patients with HIV who also have untreated hepatitis C virus (HCV) are at an even greater risk of heart attacks.

“Partly because of the inflammation from the chronic immune activation of two viral infections, we hypothesized that people living with HIV and hepatitis C would have a higher risk of heart attack with age than people living with HIV alone,” said lead study author Keri N. Althoff, PhD , MPH, Associate Professor in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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According to the American Heart Association’s 2019 “Characteristics, Prevention, and Treatment of Cardiovascular Disease in People Living with HIV,” the majority of people living with HIV are 45 years of age and older. With a median follow-up of about 4 years, the researchers set out to compare the rate of heart attacks between HIV patients and HIV-HCV patients in ten years.

The research team collected health information from patients living with HIV who were part of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) between 2000 and 2017. Their sample included 23,361 patients aged 40 to 79 years who were receiving ART and approximately 20% of patients with HIV also had HCV.

The researchers observed that an HIV patient’s risk of heart attack increases by 30% with every decade, rising to 85% if the patient was also positive for HCV. In addition, the team identified high blood pressure, smoking and type 2 diabetes as conditions that could increase heart attack risk by 46% to 90%.

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The researchers observed that participants using antiretroviral therapies – such as protease inhibitors – had a 45% increased risk. In addition, they found that participants with poorer immune function due to low CD4 immune cell levels had a 46% risk of heart attack.

Inflammation, which is associated with HIV and HCV, could be a contributing factor to an increased risk of heart attack in this population, said the study’s lead author Raynell Lang, MD, MSc, an assistant professor in the Department of Medicine and Community Health Sciences at the University of Calgary in Alberta said in a press release.

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“There may also be differences in cardiovascular disease risk factors and non-medical factors affecting the health of people with HIV and hepatitis C that play a role in the increased risk,” Lang said.

A lack of research into additional risk factors for heart attack limits the study’s findings, as does the generalization of risk factors for patients outside the United States. There are also currently advanced HCV treatments that cannot be accounted for.

“Our results suggest that HIV and hepatitis C co-infections require further research that could inform future treatment guidelines and standards of care,” Althoff said in the press release.

Relation

American Heart Association. The risk of heart attack increased with age in people with HIV and hepatitis C. EurekAlert! September 21, 2022. Accessed September 21, 2022. https://www.eurekalert.org/news-releases/964929