Neither HIV nor hepatitis C virus (HCV) infection were found to be associated with a greater risk for peripheral artery disease (PAD) in women, according to research published in AIDS. However, the study results suggest that possible early intervention targets include modifiable, traditional cardiovascular disease risk factors.
Researchers examined the relationship among HIV, HCV, and PAD in women, using data from the Women’s Interagency HIV Study cohort.
This prospective, multicenter cohort included 4982 women (3678 HIV-seropositive and 1304 HIV-seronegative but at risk for HIV infection). A total of 1899 women were included in the analysis: 57% had HIV alone, 15% had HIV/HCV coinfection, 5% had HCV alone, and 22% had neither HIV nor HCV infection. More than two-thirds of the cohort was black, and women with HCV were older than women without (median age, 54-55 vs 49-50 years).
Within the cohort, 7.7% of women had PAD. Its prevalence by infection status was 10% in patients with HIV/HCV coinfection, 5.3% in patients with HCV infection alone, 7.5% in patients with HIV infection alone, and 7.2% in patients with neither HIV nor HCV infection. The odds for PAD in unadjusted models were highest among patients with HIV/HCV coinfection (odds ratio 1.41; 95% CI, 0.83-2.39) and lowest among patients with only HCV infection (odds ratio 0.71; 95% CI, 0.27-1.89). These differences did not reach statistical significance. Demographic-adjusted multivariable logistic regression analysis found that the odds for PAD were 13% higher in patients with HIV/HCV coinfection and 39% lower in patients with HCV infection alone compared with patients without infection; however, these differences also did not reach statistical significance.
Unadjusted models revealed that older age (51-60 and 61-70 years compared with 40-50 years), a longer pack-year history of smoking, larger waist circumference, diabetes, elevated triglyceride level, elevated low-density lipoprotein cholesterol level, current statin use, and higher systolic blood pressure were significantly associated with higher odds for PAD. After multivariable adjustment, the association between PAD and older age (61-70 years), longer pack-year smoking history, and higher systolic blood pressure persisted. Multivariable analysis also “strengthened” the association between black race and PAD.
“The PAD prevalence observed in our cohort is of significant clinical concern given that general population studies have reported lower rates in similar aged adults,” the researchers noted.
Limitations include the cross-sectional design of the study and the relatively young age of participants. In addition, the study used a survivor cohort, and therefore the results may not be generalizable to other women in the United States.
“Contrary to our hypothesis, HIV and HCV infections are not significantly associated with an increased risk [for] PAD,” the researchers concluded. “Our findings suggest that targeted interventions to reduce smoking and control blood pressure are critically important in women with and at risk for HIV, particularly African Americans. Longitudinal studies and examinations of the long-term sequelae of PAD, including physical function decline, are currently underway.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Cedarbaum E, Ma Y, Scherzer R, et al. Contributions of HIV, HCV, and traditional vascular risk factors to peripheral artery disease in women [published online July 22, 2019]. AIDS. doi:10.1097/QAD.0000000000002319