Abstract
Hepatitis C virus (HCV) is common among people living with HIV (PLWH). The potential for extrahepatic manifestations of HCV, including myocardial infarction (MI), is a topic of active research. MI is classified into types, predominantly atheroembolic Type 1 MI (T1MI) and supply-demand mismatch Type 2 MI (T2MI). We examined the association between HCV and MI in the CFAR Network of Integrated Clinical Systems (CNICS), a multi-center clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Universal MI definition. We estimated the association between chronic HCV (RNA+) and time to MI adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics and substance use. Among 24,755 PLWH aged ≥18, there were 336 T1MI and 330 T2MI during a median of 4.2 years of follow-up. HCV was associated with a 68% greater risk of T2MI (adjusted hazard ratio (aHR) 1.68, 95% CI: 1.22, 2.30) but not T1MI (aHR 0.96, 95% CI: 0.63, 1.45). In a cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR 2.26, 95% CI: 1.34, 3.81). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research.
- Abbreviations
- aHR,
- adjusted hazard ratio
- AIDS,
- acquired immunodeficiency syndrome
- ART,
- antiretroviral therapy
- CFAR,
- Centers for AIDS Research
- CI,
- confidence interval
- CNICS,
- CFAR Network of Integrated Clinical Systems
- CVD,
- cardiovascular disease
- FIB-4,
- Fibrosis-4 score
- HCV,
- hepatitis C virus
- HIV,
- human immunodeficiency virus
- LDL,
- high density lipoprotein
- MI,
- myocardial infarction
- PLWH,
- people living with HIV
- RNA,
- ribonucleic acid
- T1MI,
- Type 1 myocardial infarction
- T2MI,
- Type 2 myocardial infarction