Co-infection with HIV and hepatitis C virus increases the risk of heart attack with age

People with HIV face an increased risk of heart attacks as they age, and this risk increases if they also have the hepatitis C virus (HCV), according to new research published in Journal of the American Heart Association. The good news is that managing traditional cardiovascular risk factors, controlling HIV, and treating hepatitis C can reduce risk.

Since people living with HIV live longer thanks to effective treatment, they are more likely to develop age-related conditions such as Cardiovascular disease (CVD). A large body of research has shown that people with HIV are at greater risk of developing a variety of cardiovascular problems, including atherosclerosis (a buildup of cholesterol and other substances in the arteries), coronary artery disease (blockage of the arteries that feed the heart muscle), Heart failure and heart attack (myocardial infarction).

HIV and Hepatitis C virus They share some common routes of transmission, and many people live with both viruses (known as co-infections). Hepatitis C can now be easily treated with direct-acting antivirals, but a large proportion of people with hepatitis C do not know their condition and have not received treatment.

Hepatitis C is also Associated with cardiovascular problemsHowever, the combined effect of HIV and hepatitis C virus is not well understood. Keri Altoff, PhD, MPH, of the Johns Hopkins Bloomberg School of Public Health, and colleagues aimed to determine whether co-infection with HIV/viral hepatitis B increases the risk of type 1 myocardial infarction — the type of heart attack caused by disease Coronary artery disease–and whether risk varies by age.

“Partially due to inflammation caused by chronic immune activation of a viral infection, we hypothesized that people with HIV and hepatitis C would be more likely to have heart attacks as they age compared to people with HIV alone,” Altov said in a study. American Heart Association press release.

Researchers analyzed data from 2000 to 2017 on 23,361 people living with HIV NA . Agreement (North American AIDS Collaboration on Research and Design) Participants who have started antiretroviral therapy for HIV. More than 80% were men, nearly half were white and were between 40 and 79 years old (mean 45) when they joined NA-ACCORD. One in five study participants (4,677) also had hepatitis C. Data from HIV/HCV-infected participants are no longer included after they started hepatitis C treatment.

Over a mean follow-up period of about four years, the researchers compared the incidence of heart attacks in the HIV-only and HIV/HCV groups, overall and in each decade of life.

During follow-up, there were 314 cases of type 1 myocardial infarction among people living with HIV alone and 89 cases among people living with HIV/HCV, which amount to 1.7% versus 1.9%, respectively.

In general, hepatitis C infection was not significantly associated with an increased risk of heart attack. However, while the risk of type 1 myocardial infarction increased by 30% each decade among people with HIV alone, it increased by 85% for those with both HIV and HCV.

Looking beyond the case of hepatitis C, the researchers confirmed that traditional cardiovascular risk factors, including smoking, high blood pressure and type 2 diabetes, were associated with a greater likelihood of myocardial infarction. In addition, factors associated with HIV, including a low CD4 count, a history of specific AIDS and the use of protease inhibitors, have been linked to an increased risk of heart attack.

“[T]it’s dangerous [type 1 myocardial infarction] The researchers concluded that with age it was greater in people with viral hepatitis than in those without it, and viral hepatitis status should be considered when assessing CVD risk in elderly people with HIV. “More understanding of the complex interaction between factors that influence cardiovascular risk as people with HIV age will improve their long-term care and well-being.”

“Several mechanisms may be involved in the increased risk of heart attack among patients with co-infection,” said senior study author Raynell Lange, MD, MSc, of the University of Calgary in Canada. One contributing factor may be inflammation associated with a chronic viral infection. There may also be differences in risk factors for cardiovascular disease and non-medical factors that affect health between people with HIV and hepatitis C that play a role in the increased risk.”

More than half of those infected with HIV in the United States are now Age 50 or older. The researchers wrote that as people with HIV age, reducing the risk of cardiovascular disease “is a primary treatment objective.” People infected with both HIV and hepatitis C are at greater risk of CVD,” highlighting the importance of maintaining antiretroviral therapy, promoting CVD risk reduction strategies and initiating viral hepatitis therapy to reduce chronic inflammation believed to It contributes to these risks.”

Effective and well-tolerated treatment of hepatitis C virus was not available during several years of the study period, so researchers were unable to assess the effect of treated hepatitis C on cardiovascular disease risk among people with HIV. Several studies have found that clearing of HCV is associated with reduced CVD events, but there are few data on persons with HIV/HCV co-infection. “This will be an important question to be answered in future studies,” Lang said.

In addition to treating HIV and hepatitis C, people with HIV can take other steps to reduce their risk of heart disease, including quitting smoking, eating a balanced diet, exercising, maintaining a healthy weight, and using medications. If appropriate. statins (currently being studied in REPRIEVE TRIAL). Regular checkups that include monitoring your blood pressure, blood sugar, and cholesterol levels can provide warning signs of heart problems at an early stage, when they are easier to manage.

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