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Coinfection: Two Viral Infections Can Actually Raise Your Risk Of Heart Attack – New Research

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New research published online today shows that people with HIV who also have untreated hepatitis C virus have a significantly higher risk of heart attack as they age, even if their HIV is treated.

The lifetime of HIV-positive people has drastically risen since the development of antiretroviral medicines in the late 1990s. However, studies have shown that even with therapy, people with HIV still have a heart disease risk that is at least 50% higher than that of people without HIV. The purpose of this recent study was to determine whether or not individuals infected with HIV and hepatitis C, which is a viral infection of the liver, have an increased likelihood of suffering a heart attack.

“HIV and hepatitis C coinfection occurs because they share a transmission route — both viruses may be transmitted through blood-to-blood contact,” according to senior author Keri N. Althoff.

“Due in part to the inflammation from the chronic immune activation of two viral infections,” added the senior author, “we hypothesised that people with HIV and hepatitis C would have a higher risk of heart attack as they aged compared to those with HIV alone.”

Researchers examined health data from 23,361 patients with HIV (17% female, 49% non-Hispanic white) who began antiretroviral treatment between 2000 and 2017 in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). When they enrolled in the NA-ACCORD trial, they were all between the ages of 40 and 79 (median age of 45 years). One in every five trial participants (4,677) tested positive for hepatitis C. During a median of 4 years of follow-up, the researchers evaluated the incidence of heart attacks between the HIV-only and HIV-hepatitis C co-infected groups, as well as by age group.

The research revealed:

  • Heart attacks increased by 30% in patients with HIV alone and by 85% in people with HIV plus hepatitis C who were becoming older by a decade at a time.
  • Participants who also had established risk factors for heart disease, such as high blood pressure (more than three times), smoking (90%) and Type 2 diabetes (46%), were at an increased chance of having a heart attack.
  • Additionally, participants with certain HIV-related characteristics, such as low CD4 immune cell counts (200 cells/mm3, signifying increased immunological dysfunction), and those who took protease inhibitors had a higher risk of heart attack (40%) and 45%, respectively (one type of antiretroviral therapy linked to metabolic conditions).

“People who are living with HIV or hepatitis C,” advised lead author Raynell Lang, “should ask their doctor about treatment options for the viruses and other ways to reduce their cardiovascular disease risk.”

The higher risk of heart attack among co-infected patients may be caused by a number of processes. The inflammation brought on by having two chronic viral infections may be a contributing cause, according to Lang. People with HIV and hepatitis C may have different cardiovascular disease risk factors and non-medical factors that affect their health, which could possibly contribute to the higher risk.

According to an American Heart Association scientific statement published in June 2019 titled Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV, roughly 75% of people living with HIV are over the age of 45. 

Inflammation and immunological dysregulation appear to raise the risk for heart attack, stroke, and heart failure even with good HIV viral suppression.  The statement urged additional study into the prevention, causes, and treatments of cardiovascular disease in HIV-positive individuals.

According to Althoff, these findings point to the need for additional studies on HIV and hepatitis C co-infections, which could help shape future standards of care and treatment recommendations.

The study is constrained by the lack of data on additional risk factors for heart attacks, such as nutrition, exercise, or a family history of chronic illnesses. Results from this study of HIV-positive patients receiving care in North America might not apply to HIV patients in other parts of the world.

In addition, a portion of the research durations occurred prior to the availability of more effective therapies for hepatitis C.

“Because effective and well-tolerated hepatitis C therapy was not available during several years of our study period,” Land added, “we were unable to evaluate the association of treated hepatitis C infection on cardiovascular risk among people with HIV. 

“This will be an important question to answer in future studies.”

Image Credit: Getty

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