Evaluating the Cardiovascular Risk in an Aging Population of People With HIV: The Impact of Hepatitis C Virus Coinfection

BACKGROUND: People with HIV (PWH) are at an increased risk of cardiovascular disease (CVD) with an unknown added impact of hepatitis C virus (HCV) coinfection. We aimed to identify whether HCV coinfection increases the risk of type 1 myocardial infarction (T1MI) and if the risk differs by age. METHODS AND RESULTS: We used data from NA‐ACCORD (North American AIDS Cohort Collaboration on Research and Design) from January 1, 2000, to December 31, 2017, PWH (aged 40–79 years) who had initiated antiretroviral therapy. The primary outcome was an adjudicated T1MI event. Those who started direct‐acting HCV antivirals were censored at the time of initiation. Crude incidence rates per 1000 person‐years were calculated for T1MI by calendar time. Discrete time‐to‐event analyses with complementary log–log models were used to estimate adjusted hazard ratios and 95% CIs for T1MI among those with and without HCV. Among 23 361 PWH, 4677 (20%) had HCV. There were 89 (1.9%) T1MIs among PWH with HCV and 314 (1.7%) among PWH without HCV. HCV was not associated with increased T1MI risk in PWH (adjusted hazard ratio, 0.98 [95% CI, 0.74–1.30]). However, the risk of T1MI increased with age and was amplified in those with HCV (adjusted hazard ratio per 10‐year increase in age, 1.85 [95% CI, 1.38–2.48]) compared with those without HCV (adjusted hazard ratio per 10‐year increase in age,1.30 [95% CI, 1.13–1.50]; P<0.001, test of interaction). CONCLUSIONS: HCV coinfection was not significantly associated with increased T1MI risk; however, the risk of T1MI 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 PWH.