Association between chronic Hepatitis C virus infection and myocardial infarction among people living with HIV in the United States

Jessica Williams-Nguyen, Stephen E. Hawes, Robin M. Nance, Sara Lindström, Susan R. Heckbert, H. Nina Kim, W. Chris Mathews, Edward R. Cachay, Matt Budoff, Christopher B. Hurt, Peter W. Hunt, Elvin Geng, Richard D. Moore, Michael J. Mugavero, Inga Peter, Mari M. Kitahata, Michael S. Saag, Heidi M. Crane, Joseph A. Delaney

Research output: Contribution to journalArticlepeer-review

Abstract

Hepatitis C virus (HCV) infection is common among people living with human immunodeficiency virus (PLWH). Extrahepatic manifestations of HCV, including myocardial infarction (MI), are 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 among patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, a US multicenter clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Third Universal Definition of Myocardial Infarction. We estimated the association between chronic HCV (RNA+) and time to MI while adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics, and history of injecting drug use. Among 23,407 PLWH aged ≥18 years, there were 336 T1MIs and 330 T2MIs during a median of 4.7 years of follow-up between 1998 and 2016. HCV was associated with a 46% greater risk of T2MI (adjusted hazard ratio (aHR) = 1.46, 95% confidence interval (CI): 1.09, 1.97) but not T1MI (aHR = 0.87, 95% CI: 0.58, 1.29). In an exploratory cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR = 2.01, 95% CI: 1.25, 3.24). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research.

Original languageEnglish (US)
Pages (from-to)554-563
Number of pages10
JournalAmerican journal of epidemiology
Volume189
Issue number6
DOIs
StatePublished - Jun 1 2020

Keywords

  • Chronic hepatitis C infection
  • HIV
  • HIV coinfection
  • Hepatitis C virus
  • Myocardial infarction
  • People living with HIV
  • Type 2 myocardial infarction

ASJC Scopus subject areas

  • Epidemiology

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