Among patients coinfected with HIV and hepatitis C virus (HCV), eradication of HCV had no effect on markers of preclinical atherosclerosis and biomarkers of inflammation and endothelial dysfunction, according to data published in the Journal of Acquired Immunodeficiency Syndrome. However, associations with a clinically relevant rise in serum low-density lipoprotein cholesterol (LDL-C) were revealed.
The link between HCV infection and cardiovascular events has been tenuous and controversial. Several studies, including meta-analyses, have concluded that HCV infection is associated with an increased cardiovascular disease and related mortality, and stroke; however, several other studies found no association between HCV and coronary artery disease.
Therefore, researchers conducted a prospective study to assess the effects of HCV eradication on cardiovascular risk and preclinical atherosclerosis in this population. The investigators assessed serum lipids, 10-year Framingham cardiovascular risk scores, pulse wave velocity, carotid intima-media thickness, as well as biomarkers of inflammation and endothelial dysfunction at baseline and 96 weeks after initiation of anti-HCV therapy in 237 patients coinfected with HIV and HCV.
Anti-HCV therapies consisted of pegylated interferon and ribavirin plus 1 direct-acting antiviral (DAA) in 55.2% of patients, pegylated interferon and ribavirin in 33.8%, and all-oral DAA in 11.0% of patients.
Sustained viral response (SVR) was achieved in 62% of patients. There were median increases in LDL-C in patients with and without SVR: 14 mg/dl and 0 mg/dl (P =.024), respectively. In 26.9% of patients with SVR, increases in cardiovascular risk categories, including the Framingham risk score, were observed (P =.005 vs baseline) compared with 8.1% of patients without SVR (P =.433). This resulted in a significant interaction between SVR and cardiovascular risk over time (P <.001), but no significant effect of SVR was found for pulse wave velocity (P =.446), carotid intima-media thickness (P =.320), or biomarkers of inflammation and endothelial dysfunction.
The researchers highlighted the fact that the identified association between SVR and increases in Framingham 10-year cardiovascular risk was mediated by an increase in serum LDL-C in patients who responded to treatment.
The investigators noted that this study was not intended to assess the effect of HCV eradication on clinical outcomes and that outcomes were assessed in the medium, not long term. The study also had a relatively small sample size that may be insufficient to detect significant changes in the studied effects. They reported, however, that by using highly sensitive methods of statistics, high P-values for the effects of SVR were found. Therefore, “while significant changes were observed in much larger cohorts, the clinical effect of these findings seems questionable.”
Based on these findings, the investigators concluded that there was no support for medium-term beneficial effects of SVR on markers of preclinical atherosclerosis and plasmatic concentrations of proinflammatory and endothelial dysfunction biomarkers in this study population. In fact, researchers found an association between HCV clearance and a clinically relevant rise in serum LDL-C, suggesting, “that evaluation of CVR should be an integral part of care following the cure of chronic hepatitis C in patients with HIV.”
Carrero A, Berenguer J, Hontañón V, et al. Effects of eradication of HCV on cardiovascular risk and preclinical atherosclerosis in HIV/HCV-coinfected patients [published online January 6 2020]. J Acquir Immune Defic Syndr. doi:10.1097/QAI.0000000000002260