LDL cholesterol and triglycerides levels are independent predictors of cardiovascular events in HIV-HCV co-infected patients: ANRS CO13-HEPAVIH
Background: HIV
infection increases the risk of mortality with cirrhosis, liver failure and
hepatocarcinoma in HCV co-infected patients. The risk and spectrum of cardiovascular
diseases (CVD) in this population are not well assessed with contradictory
previous results.
Methods: We
used the French prospective multi-center HEPAVIH-ANRS CO13 cohort, to
prospectively study all major (acute coronary syndrome, coronary revascularization,
death by cardio-vascular cause, ischemic stroke) and minor (thrombo-embolic
disease, peripheral arteriopathy, congestive heart failure) CVD events that
occurred in the cohort, assess their incidence and screen CVD predictors. Chi 2
test was used for qualitative values and Wilcoxon test for quantitative values
to screen potential CVD predictors. A Cox model was performed to identify CVD
predictors among adjusted selected parameters with a p< 0,10 in univariate
analysis.
Results: Among 1175
HIV-HCV co-infected patients (70,4% men, mean age: 45,0 years) included from
January 2006 to January 2008 and followed till September 2013 (median follow-up:
57,6 months), we observed a total of 42 total CVD events for 28 patients
experiencing a CVD event. The incidence of
all events was 8.3 per 1000 person-years (CI95= 5,0-11,6) and 5.6 per 1000 person-years
(CI95= 2,3-8,9) for a first event.
Atherosclerotic
CVD events including 4 deaths by cardio-vascular cause, 10 acute coronary
syndromes, 1 coronary revascularization, and 2 ischemic brain strokes were
observed. Other CVD events were 8 peripheral arteriopathies and 3
thrombo-embolic venous diseases.
As compared
with patients without CVD, patients who developed a CVD event were more
frequently men (p=0.0092), had a higher median CD8 cell count (p=0.0394), were
more frequently lipoatrophic (p=0.0399), had a higher total cholesterol level (p=0.0165),
LDL cholesterol level (p=0.0132) and triglyceride level (p=0.0002). Otherwise, HCV
eradication by antiretroviral treatment didn''t influence the occurrence of CVD
events (p=0,1730).
A multivariate analysis identified serum
LDL-cholesterol (RR=6.202 CI95=
1,580-24,352, p=0,0089)
and triglyceride level (RR=2,010,
CI95= 1,207-3,347, p=0,0076) as independent predictors of CVD.
Conclusions: In HIV-HCV co-infected patients, CVD events are mainly
driven by atherosclerotic CVD particularly acute coronary syndromes and
peripheral vascular diseases. Serum LDL-cholesterol and triglyceride levels
appear as independent CVD
predictors.
B.K. Tan1,2, C. Gilbert3, F. Bocarra4, M.A. Loko3, F. Dabis3, M. Kante1, H. Mehawej1, I. Poizot5, J. Delaune3, L. Piroth6, F. Bani-Sadr7, M.P. Carrieri8, P. Sogni2,9, D. Salmon1,2, HEPAVIH ANRS CO13
1Cochin Hospital, Infectious Diseases Unit, Paris, France, 2Paris V Descartes University, Medicine Faculty, Paris, France, 3Bordeaux Segalen University, INSERM U 897 Center of Epidemiologics and Satistics, Bordeaux, France, 4Saint-Antoine Hospital, Cardiology Department, Paris, France, 5Sainte-Marguerite Hospital, Immunology and Hematology Department, Marseille, France, 6Bocage Hospital, Infectious Diseases Department, Dijon, France, 7Robert Debré Hospital, Infectious Diseases Unit, Reims, France, 8Organisme Régional de Santé PACA, SESSTIM UMR 912, Marseille, France, 9Cochin Hospital, Hepatology Department, Paris, France