The risk of myocarditis for patients with HIV is not necessarily associated with a Hepatitis C virus (HCV) co-infection, but this risk increases with patient age.
A team led by Raynell Lang, MD, MSc, Department of Medicine, , University of Calgary determined whether HCV co-infections increase the risk of type 1 myocardial infarction and whether the risk varies with age.
An unknown risk
Patients with HIV are often at increased risk for cardiovascular disease, but the impact of HCV co-infections is not yet understood. Some studies have found a 50-75% increased risk of cardiovascular disease in patients with HIV compared to those without HIV.
“The risk of CVD in people with hepatitis C virus (HCV) infection alone is not as consistent, with some studies showing an increased risk and others showing no association,” the authors write. “Due to common transmission routes, HIV/HCV co-infection is common worldwide (10-30%). Less is known about cardiovascular risk in PGH with HCV, particularly in an aging population on contemporary antiretroviral therapy (ART).”
Data from North America
In the study, the researchers used data from NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) from the years 2000-2017 for patients with HIV aged between 40-79 years who had started antiretroviral therapy. NA-ACCORD is a collaboration of 29 clinical and interval cohorts from the United States and Canada and the North American region of the International Epidemiology Databases to Evaluate AIDS.
Investigators were looking for primary outcomes of a confirmed type 1 myocarditis event. Patients who started direct-acting HCV antiviral drugs were censored at the time of treatment initiation.
The team then calculated the crude incidence rates per 1000 person-years for type 1 myocardium by calendar time. They also estimated adjusted hazard ratios and 95% confidence intervals for type 1 myocarditis using discrete time-to-event analyzes with supplemental log-logm models in patients with and without HCV.
Comparison of patients with and without HCV
A total of 23,361 patients with HIV, 20% (n=4,677) had HCV. 89 (1.9%) patients with type 1 myocarditis had HIV and HCV co-infection and 314 (1.7%) patients with HIV without HCV co-infection had type 1 myocarditis.
The results show that HCV was not associated with an increased risk of type 1 myocarditis in patients with HIV (aHR, 0.98; 95% CI, 0.74-1.30).
This risk also increased with age and was higher in patients with HCV (aHR per 10-year increase in age, 1.85; 95% CI, 1.38-2.48) compared to patients without HCV (aHR per 10-year increase in age, 1.30; 95% CI, 1.13-1.50) (P <.001, interaction test).
“HCV co-infection was not significantly associated with an increase [type 1 myocarditis infarction] Risk; however, the risk of [type 1 myocarditis infarction] with increasing age was greater in those with HCV than in those without, and HCV status should be considered when assessing cardiovascular risk with age [people with HIV]’ the authors write.
The study Evaluating the Cardiovascular Risk in an Aging Population of People With HIV: The Impact of Hepatitis C Virus Cofection was published online in Journal of the American Heart Association.