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

By 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

Posted 26 Oct 2018
bioRxiv DOI: 10.1101/453860

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.

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