Heart attack risks increase as people with HIV and hepatitis C age, according to recent study

by American Heart Association

DALLAS -- As people with HIV age, their risk of heart attack increases far more if they also have untreated hepatitis C virus, even if their HIV is treated, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Since the introduction of antiretroviral therapies to treat HIV in the late 1990s, the lifespan of people with HIV has increased dramatically. However, even with treatment, studies have found the heart disease risk among people with HIV is at least 50% higher than people without HIV. This new study evaluated if people with HIV who also have hepatitis C – a viral liver infection – have a higher risk of heart attack.

"HIV and hepatitis C coinfection occurs because they share a transmission route - both viruses may be transmitted through blood-to-blood contact," said Keri N. Althoff, Ph.D., M.P.H., senior author of the study and an associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "Due in part to the inflammation from the chronic immune activation of two viral infections, we hypothesized that people with HIV and hepatitis C would have a higher risk of heart attack as they aged compared to those with HIV alone."

Researchers analyzed health information for 23,361 people with HIV (17% female, 49% non-Hispanic white) in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) between 2000 and 2017 and who had initiated antiretroviral treatment for HIV. All were between 40 to 79 years of age when they enrolled in the NA-ACCORD study (median age of 45 years). One in 5 study participants (4,677) were also positive for hepatitis C. During a median follow-up of about 4 years, the researchers compared the occurrence of a heart attack between the HIV-only and the HIV-hepatitis C co-infected groups as a whole, and by each decade of age.

The analysis found:

With each decade of increasing age, heart attacks increased 30% in people with HIV alone and 85% in those who were also positive for hepatitis C.

The risk of heart attack increased in participants who also had traditional heart disease risk factors such as high blood pressure (more than 3 times), smoking (90%) and Type 2 diabetes (46%).

The risk of heart attack was also higher (40%) in participants with certain HIV-related factors such as low levels of CD4 immune cells (200cells/mm3, signaling greater immune dysfunction) and 45% in those who took protease inhibitors (one type of antiretroviral therapy linked to metabolic conditions).

"People who are living with HIV or hepatitis C should ask their doctor about treatment options for the viruses and other ways to reduce their cardiovascular disease risk," said lead study author Raynell Lang, M.D., M.Sc., an assistant professor in the department of medicine and community health sciences at the University of Calgary in Alberta, Canada.

"Several mechanisms may be involved in the increased heart attack risk among co-infected patients. One contributing factor may be the inflammation associated with having two chronic viral infections," Lang said. "There also may be differences in risk factors for cardiovascular disease and non-medical factors that influence health among people with HIV and hepatitis C that plays a role in the increased risk."

According to a June 2019 American Heart Association scientific statement, Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV, approximately 75% of people living with HIV are over the age of 45. "Even with effective HIV viral suppression, inflammation and immune dysregulation appear to increase the risk for heart attack, stroke and heart failure." The statement called for more research on cardiovascular disease prevention, causes and treatment in people with HIV.

"Our findings suggest that HIV and hepatitis C co-infections need more research, which may inform future treatment guidelines and standards of care," Althoff said.

The study is limited by not having information on additional factors associated with heart attack risk such as diet, exercise or family history of chronic health conditions. Results from this study of people with HIV receiving care in North America may not be generalizable to people with HIV elsewhere. In addition, the study period included time prior to the availability of more advanced hepatitis C treatments.

"Because effective and well-tolerated hepatitis C therapy was not available during several years of our study period, we were unable to evaluate the association of treated hepatitis C infection on cardiovascular risk among people with HIV. This will be an important question to answer in future studies," Lang said.

Prep Sports Notebook: Unity top in XC, SJO soccer post another win

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Rockets take 4th place at Reed-Custer Lady Comets Classic

BRAIDWOOD -- Unity won one match, tied two, and lost two at the Lady Comets volleyball tournament on Saturday.

The Rockets fell 2-0 to Maroa-Forsyth and De La Salle in close contests. The Trojans prevailed 25-23, 25-14, and the Meteors from Chicago squeaked by UHS, 25-18, 25-20.

The team split sets against Putnam County, losing the first by three, 25-22, and storming back to take the second set, 25-18. Kaitlyn Schweighart, who finished the tournament with 18 kills and 58 digs, and the Rockets also split sets in their confrontation with the Momence volleyball program, 17-25, 25-16.

UHS' only victory on the five-match day was 25-23, 25-11, win over Mendota.

Junior Ruby Tarr had 33 assists and made 22 digs during the tournament. Meanwhile, Jayci McGraww booked 31 assists and five digs, and Julia Ping helped the team's defensive effort collecting 35 digs and nine assists.

The Rockets are back in action two days next week at the Rocket Center. Starting Monday, Tarr & Co. host the Bulldogs of St. Teresa and then play a conference showdown against the Monticello. The Sages are 0-2 in conference play with straight two-set loses to St. Thomas More and Paxton-Buckley-Loda this season.

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Spartans one win away from 10th

GEORGETOWN -- The St. Joseph-Ogden soccer team rallied back from a one-goal first-half deficit with two goals to beat Georgetown-Ridge Farm-Westville, 2-1.

The Buffaloes produced the only score in the first half despite numerous opportunities for SJO. A pass from freshman Ryker Lockhart gave Collin Thomey the opportunity to tie the game 1-all in the second half. Later, Lockhart put the ball between the post around the GRFW keeper to give the Spartans the go-ahead goal. Spencer Wilson got credit for the assist for the 9-3-1 Spartans.

Senior Hunter Ketchum and backup keeper Jacek Slowikowski, each guarding the goal for a half, made two saves each.

Luke Barney nailed the first goal of the game for the Buffaloes.

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Unity outscored, 2-0

Tolono -- The Rockets' soccer team fell 2-0 to visiting Illinois Valley Central Saturday morning. The Grey Ghosts improved to 1-4 in conference play after scoring a goal in each half of the Illini Prairie Conference match.

Unity (2-13, 0-6) hosts Fisher on Monday at home. Opening kick is slated for 4:30p.

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SJO 4th, Unity 9th at cross-country meet

St. Joseph -- St. Joseph-Ogden's Jack Fisher turned in a team-best 16:10.32 finish to help the Spartans finish fourth out of 28 participating teams after running in the 50th installment of the Spartan Classic.

The Rockets, who finished ninth in the team standings, were paced by Brendan Graven. He completed the 3-mile course in 16 minutes and 38.58 seconds Saturday morning. Urbana University High's Pieter Duursma led the Illinek's effort to the finish line, circumventing the course for a 34th overall finish at 16:51.57.

The St. Teresa boys' team won this year's team title with 60 points. El Paso-Gridley finished in second place with 92 points, and third place went to Tuscola with 113 points.

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Unity girls when Spartan Classic title

St. Joseph -- The Rockets cross-country team finished first out of 27 teams at this year's Spartan Classic. Uni-High finished in third place with 149 points behind El Paso-Gridley's 97-point second-place effort. Unity's top-five runners finished the 3-mile course under 19 minutes or better for an impressive 38 points.

The St.Joseph-Ogden harriers finished in seventh place in the team standings.

Rockets' Erika Woodard, a junior, won the individual title crossing the finish line first for the ladies with a time of 17:12.28. Senior Kate Ahmari, who led the Illinek program around the course throughout St. Joseph, finished at 17:49.40 in 3rd place overall. The Spartans top runner, sophomore Savanna Franzen, clocked in at 18:02.08 for a 6th place finish overall.

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Attention area high school coaches

If you are a coach at Unity, Urbana Uni-High, Urbana High School or St. Joseph-Ogden, send us your box scores, statistical leaders for each game, and other info via email to sports@oursentinel.com or editor@oursentinel.com.

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