Hepatitis C Not Significantly Associated With Myocarditis Risk for HIV Patients

Raynell Lang, MD, MSc

The risk of myocarditis for patients with HIV is not necessarily associated with a hepatitis C virus (HCV) coinfection, but this risk does increase as the patient ages.

A team, led by Raynell Lang, MD, MSc, Department of Medicine, , University of Calgary, identified whether HCV coinfections increases the risk of type 1 myocardial infarction and if the risk differs by age.

An Unknown Risk

Patients with HIV are often at an elevated risk of cardiovascular disease, but the impact of HCV coinfections is not yet understood. Some studies have found a 50-75% increased risk of cardiovascular disease in patients with HIV, compared to patients without HIV.

“The risk of CVD among people with hepatitis C virus (HCV) infection alone is not as consistent, with some studies demonstrating increased risk and others showing no association,” the authors wrote. “Because of shared transmission routes, HIV/HCV coinfection is common (10%–30%) globally. Less is known about CVD risk among PWH with HCV, particularly within an aging population on contemporary antiretroviral therapy (ART).”

Data From North America

In the study, the investigators used data from the NA‐ACCORD (North American AIDS Cohort Collaboration on Research and Design) from 2000-2017 for patients with HIV aged between 40-79 years who had initiated antiretroviral therapy. NA‐ACCORD is a collaboration of 29 clinical and interval cohorts from the US and Canada, and the North American region of the International epidemiology Databases to Evaluate AIDS.

The investigators sought primary outcomes of an adjudicated type 1 myocarditis event. Patients who started direct-acting HCV antivirals were censored at the time of initiation.

The team then calculated crude incidence rates per 1000 person-years for type 1 myocardial by calendar time. They also estimated adjusted hazard ratios and 95% confidence intervals for type 1 myocarditis using discrete time-to-event analyses with complementary log-logm models among patients with and without HCV.

Comparing Patients With and Without HCV

Overall, 23,361 patients with HIV, 20% (n = 4677) had HCV. There were 89 (1.9%) patients with type 1 myocarditis had HIV and HCV coinfections and 314 (1.7%) of patients with HIV without HCV coinfections had type 1 myocarditis.

The results show HCV was not linked to an increased risk type 1 myocarditis in patients with HIV (aHR, 0.98; 95% CI, 0.74-1.30).

This risk also increased with age and was amplified in patients with HCV (aHR per 10-year increase in age, 1.85; 95% CI, 1.38-2.48) compared to patients without HCV (aHR per 10-year increase in age, 1.30; 95% CI, 1.13-1.50) (P <.001, test of interaction).

“HCV coinfection was not significantly associated with increased [type 1 myocarditis infarction] risk; however, the risk of [type 1 myocarditis infarction] with increasing age was greater in those with HCV compared with those without, and HCV status should be considered when assessing CVD risk in aging [people with HIV],” the authors wrote.

The study, “Evaluating the Cardiovascular Risk in an Aging Population of People With HIV: The Impact of Hepatitis C Virus Coinfection,” was published online in the Journal of the American Heart Association.