Risk of cardiovascular disease associated with HCV and HBV coinfection among antiretroviral-treated HIV-infected individuals
Risk of cardiovascular disease associated with HCV and HBV coinfection among antiretroviral-treated HIV-infected individuals
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DOI：
10.3851/imp2724
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发表时间：
2014-01-01
影响因子：
1.2
通讯作者：
Raboud, Janet M.
中科院分区：
文献类型：
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作者：
Gillis, Jennifer;Smieja, Marek;Raboud, Janet M.
背景：HIV感染者心血管疾病（CVD）的风险增加是公认的。尽管高流行率的病毒性肝炎合并感染HIV，有几个研究中的抗逆转录病毒疗法（ART）治疗的合并感染patients.Methods：安大略艾滋病治疗网络队列研究参与者开始ART没有以前的心血管事件进行了分析。通过血清学和RNA检测结果确定HBV和HCV合并感染。CVD定义为以下任一项：冠状动脉疾病，包括动脉粥样硬化、慢性缺血性心脏病和动脉血管疾病;心肌梗塞;充血性心力衰竭;脑血管意外或中风;冠状动脉搭桥术;血管成形术;和心源性猝死。HBV和HCV合并感染对CVD时间的影响进行了评估，使用多变量竞争风险模型占ART启动和研究enrollment.Results之间的左截断：共3,416 HIV单感染，432 HIV-HBV-和736 HIV-HCV-合并感染的个人进行了随访，中位数（IQR）为2.32年（1.36-8.02）。在研究期间，记录了167例CVD事件和613例死亡。在调整年龄、性别、种族、开始ART的年份、体重和吸烟状况后，HBV与至CVD发作的时间无关（aHR=1.05，95% CI [0.63，1.74]; P=0.86）。HCV合并感染者的心血管疾病风险升高，接近统计学显著性（aHR=1.44，95%CI [0.97，2.13]; P=0.07）。结论：我们的研究结果与HIV-HCV合并感染者相对于HIV单独感染者的心血管疾病中度增加一致，支持考虑启动HCV抗病毒治疗。
Background: The increased risk for cardiovascular disease (CVD) in HIV is well established. Despite high prevalence of viral hepatitis coinfection with HIV, there are few studies on the risk of CVD amongst antiretroviral therapy (ART)-treated coinfected patients.Methods: Ontario HIV Treatment Network Cohort Study participants who initiated ART without prior CVD events were analysed. HBV and HCV coinfection were identified by serology and RNA test results. CVD was defined as any of: coronary artery disease including atherosclerosis, chronic ischaemic heart disease and arteriosclerotic vascular disease; myocardial infarction; congestive heart failure; cerebrovascular accident or stroke; coronary bypass; angioplasty; and sudden cardiac death. The impact of HBV and HCV coinfection on time to CVD was assessed using multivariable competing risk models accounting for left truncation between ART initiation and study enrolment.Results: A total of 3,416 HIV-monoinfected, 432 HIV-HBV-and 736 HIV-HCV-coinfected individuals were followed for a median (IQR) of 2.32 years (1.36-8.02). Over the study period, 167 CVD events and 613 deaths were documented. After adjustment for age, gender, race, year initiating ART, weight and smoking status, HBV was not associated with time to CVD onset (aHR=1.05, 95% CI [0.63, 1.74]; P=0.86). There was an elevated risk of CVD for HCV-coinfected individuals, which approached statistical significance (aHR=1.44, 95% CI [0.97, 2.13]; P=0.07).Conclusions: Our results are consistent with a moderate increase of CVD among individuals with HIV-HCV coinfection relative to those with HIV infection alone, lending support to consideration of initiation of HCV antiviral treatment.