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Burrowes SAB, Zisman E, Fantry LE, Bui Q, Wu A, Sorkin J, Miller M, Bagchi S. Changes in Atherosclerotic Cardiovascular Disease Risk Scores in a Predominantly Black Cohort with HIV and Associated Comorbidities: A Preliminary Study. Cardiology 2024:1-9. [PMID: 39106839 DOI: 10.1159/000540526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/18/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION People with HIV (PWH) have an increased risk of atherosclerotic cardiovascular disease (ASCVD) compared to non-PWH, but the reasons for this increased risk remain elusive. We investigated the change in ASCVD risk scores over 4 years to identify clinical factors associated with change in risk scores or high-risk scores. METHODS We conducted a preliminary study using retrospective analysis of PWH, between 40 and 75 years old, seen at the Evelyn Jordan Center with at least two routine HIV visits. We collected clinical and demographic data and calculated the ASCVD risk scores using the Pooled Cohort Equation. Exploratory analyses examined change in risk score categories over time. Final adjusted analysis examined factors associated with change in continuous risk scores over time. RESULTS Our sample included 187 PWH; 166 were black/African American and 79 were female. We found no significant change in ASCVD risk score over time. The risk score was significantly higher in PWH with hepatitis C (7.34%; 95% CI: 2.59, 12.09; p = 0.003) and trended higher in those with dual hepatitis B/C and hepatitis B compared to those without hepatitis (p = 0.07). CONCLUSION We found that ASCVD risk did not change over a 4-year period among predominantly black young PWH, but infection with hepatitis C and dual hepatitis B/C were associated with higher ASCVD risk scores. Our findings illustrate the need for further longitudinal studies evaluating change in cardiovascular disease (CVD) risk and investigating viral hepatitis as an added potential contributor to increased CVD risk in high-risk, vulnerable populations.
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Affiliation(s)
- Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Erin Zisman
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lori E Fantry
- Division of Infectious Diseases, University of Arizona/Banner University Medical Center, Tucson, Arizona, USA
| | - Quoc Bui
- Center for Biostatistics and Data Science Institute for Informatics, Data Science & Biostatistics, Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela Wu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John Sorkin
- Division of Gerontology and Palliative Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Baltimore VA Geriatrics Research, Education and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Michael Miller
- Department of Medicine, Corporal Michael J Crescenz VAMC, Philadelphia, Pennsylvania, USA
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shashwatee Bagchi
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Wu VCC, Huang CH, Wang CL, Lin MH, Kuo TY, Chang CH, Wu M, Chen SW, Chang SH, Chu PH, Wu CS, Lin YS. Cardiovascular outcomes in hepatitis C virus infected patients treated with direct acting antiviral therapy: a retrospective multi-institutional study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:507-514. [PMID: 37170917 DOI: 10.1093/ehjcvp/pvad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is associated with increased cardiovascular risks. We aimed to investigate the impact of direct acting antiviral (DAA) on HCV-associated cardiovascular events. METHODS In this retrospective cohort study, patients with the diagnosis of chronic HCV were retrieved from multi-institutional electronic medical records, where diagnosis of HCV was based on serum HCV antibody and HCV-RNA test. The patients eligible for analysis were then separated into patients with DAA treatment and patient without DAA treatment. Primary outcomes included acute coronary syndrome, heart failure (HF), venous thromboembolism (VTE), stroke, cardiovascular death, major adverse cardiovascular event (MACE), and all-cause mortality. Outcomes developed during follow-up were compared between DAA treatment and non-DAA treatment groups. RESULTS There were 41 565 patients with chronic HCV infection identified. After exclusion criteria applied, 1984 patients in the DAA treatment group and 413 patients in the non-DAA treatment group were compared for outcomes using inverse probability of treatment weighting. Compared to patients in non-DAA treatment group, patients in DAA treatment group were associated with significantly decreased HF (hazard ratio [HR]: 0.65, 95% confidence interval [CI]: 0.44-0.97, P = 0.035), VTE (HR: 0.19, 95% CI: 0.07-0.49, P = 0.001), MACE (HR: 0.73, 95% CI 0.59-0.92, P = 0.007), and all-cause mortality (HR: 0.50, 95% CI: 0.38-0.67, P < 0.001) at 3-year follow-up. CONCLUSIONS Chronic HCV patients treated with DAA experienced lower rates of cardiovascular events and all-cause mortality than those without treatment. The reduction of VTE was the most significant impact of DAA treatment among the cardiovascular outcomes.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
| | - Chien-Hao Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 613016, Taiwan
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital Chiayi Branch, Chiayi 613016, Taiwan
| | - Chih-Hsiang Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
| | - Michael Wu
- Divison of Cardiovascular Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan
| | - Cheng-Shyong Wu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
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Goble SR, Nyembo P, Rodin H, Konstantinides G, Powell J, Noska AJ. Statin Utilization Among Individuals Infected With Hepatitis C Virus: A Retrospective Cohort Study. Cureus 2023; 15:e36049. [PMID: 37056557 PMCID: PMC10089619 DOI: 10.7759/cureus.36049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/13/2023] Open
Abstract
Introduction and Objectives Statin use for primary prevention of coronary artery disease (CAD) has historically been limited in patients with chronic liver disease due to concerns for increased adverse events with statin use in this population. We aimed to quantify the underutilization of statins among individuals with a history of HCV infection in a community health system to understand the clinical implications of statin underutilization in a diverse, generalizable population of patients infected with HCV. Materials and Methods We performed a single-center retrospective study of individuals with a history of HCV infection aged 40-75 years from 2019-2021. Statin eligibility was determined using the 2019 American College of Cardiology/American Heart Association (ACC/AHA) guidelines with the 2013 Pooled Cohort Equation used to determine atherosclerotic cardiovascular disease (ASCVD) risk. Baseline characteristics and adverse events of statin and non-statin users were compared, and factors associated with statin use were determined using multivariable logistical regression. Results Based on 2019 ACC/AHA guidelines, 752/1,077 (69.8%) subjects had an indication for a statin, 280/752 (37.2%) of which were treated with a statin. Cirrhosis was independently associated with statin underutilization. Diabetes, anti-hypertensive use, and Black race were all independently associated with statin use in subjects with an indication for therapy. Statin use was not associated with adverse events. Conclusions Statins were underutilized and well tolerated in the cohort of individuals with a history of HCV infection. This high-risk population would benefit from increased CAD screening and utilization of statins for the primary prevention of CAD.
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Xiao Y, Ba Z, Pang S, Liu D, Wang H, Liang H, Wang Y, Yuan J. PCSK9 Inhibitor: Safe Alternative to Fill the Treatment Gap in Statin-Limited Conditions? Rev Cardiovasc Med 2022; 23:380. [PMID: 39076187 PMCID: PMC11269069 DOI: 10.31083/j.rcm2311380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 07/31/2024] Open
Abstract
Lipid-lowering therapy is of great importance in reducing the burden of atherosclerotic cardiovascular disease. Statins act as first-line therapy in the current lipid management guidelines. However, statin use is limited in (1) statin-induced adverse events, including statin-associated muscle symptoms, new-onset diabetes mellitus, drug-induced liver injuries, acute kidney injuries, cognitive effects, hemorrhagic strokes, and cataracts; (2) special populations, including pregnant and lactating patients, patients with decompensated cirrhosis, and patients on dialysis; (3) coadministration with statin-interactive drugs, such as anti-human immunodeficiency virus drugs, anti-hepatitis C virus drugs, and immunosuppressive drugs. These considerable statin-limited groups are in urgent need of safer alternative lipid-lowering options. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are attracting widespread attention for their documented safety in general populations and superior lipid-lowering properties. Therefore, questions have been raised whether PCSK9 inhibitors could be a safe alternative in patients who are intolerant to statin therapy. In this review, we discuss the safety of PCSK9 inhibitors in statin-limited conditions. We conclude that PCSK9 inhibitors are a safe alternative lipid-lowering therapy in various statin-limited conditions. Furthermore, we identify several limitations in the current literature and suggest future directions, for the refinement of lipid management regimens.
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Affiliation(s)
- Ying Xiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing,
China
| | - Zhengqing Ba
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing,
China
| | - Shurui Pang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences
& Peking Union Medical College, 100730 Beijing, China
| | - Dong Liu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing,
China
| | - Hao Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
& Peking Union Medical College, 100730 Beijing, China
| | - Hanyang Liang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing,
China
| | - Yong Wang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing,
China
| | - Jiansong Yuan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences & Peking Union Medical College, 100037 Beijing,
China
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Ramadan MS, Boccia F, Moretto SM, De Gregorio F, Gagliardi M, Iossa D, Durante-Mangoni E, Zampino R. Cardiovascular Risk in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals. J Clin Med 2022; 11:5781. [PMID: 36233646 PMCID: PMC9572655 DOI: 10.3390/jcm11195781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic hepatitis C (CHC) is associated with hepatic and extrahepatic complications, including cardiovascular disease (CVD). The effects of sustained virological response (SVR) and liver fibrosis on CVD risk are not well established. Aims: We aim to assess the dynamics of Fibrosis-4 (FIB-4) and Atherosclerotic Cardiovascular Disease 2013 (ASCVD) scores up to three years after direct acting antivirals (DAA) treatment and explore the time-dependent association between the two scores. Methods: We included consecutive CHC patients treated with DAA and followed up with them for three years. Outcomes were changes from baseline (before DAA) in ASCVD and FIB-4 scores, measured at the end of treatment, 12-, 24-, and 36-months follow-up. Results: In total, 91 patients with CHC were finally included (median age: 66 years (IQR = 58−72 years); 43% females). Median follow-up was 2 years (1−3 years) and all patients reached SVR. The ASCVD score did not significantly change from baseline (Mean = 17.2%, 95% CI 14.1, 20.3), but the FIB-4 score significantly decreased at any time-point by an average of 0.8 (95% CI 0.78, 0.82, p < 0.001). Elevated FIB-4 scores at one (β = 1.16, p < 0.001) and three years (β = 2.52, p < 0.001) were associated with an increased ASCVD score. Clinically, two participants- with non-decreasing FIB-4 scores after treatment- had acute coronary syndrome at the end of treatment and one year follow-up, respectively. Conclusions: In our study, we found that FIB-4 and ASCVD scores exhibited a positive correlation irrespective of time-point after treatment. Larger studies are essential to further investigate the utility of FIB-4 scores in cardiovascular risk assessment.
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Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
| | - Filomena Boccia
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Simona Maria Moretto
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Fabrizio De Gregorio
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Massimo Gagliardi
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Domenico Iossa
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
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Moran CA, Collins LF, Beydoun N, Mehta PK, Fatade Y, Isiadinso I, Lewis TT, Weber B, Goldstein J, Ofotokun I, Quyyumi A, Choi MY, Titanji K, Lahiri CD. Cardiovascular Implications of Immune Disorders in Women. Circ Res 2022; 130:593-610. [PMID: 35175848 PMCID: PMC8869407 DOI: 10.1161/circresaha.121.319877] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immune responses differ between men and women, with women at higher risk of developing chronic autoimmune diseases and having more robust immune responses to many viruses, including HIV and hepatitis C virus. Although immune dysregulation plays a prominent role in chronic systemic inflammation, a key driver in the development of atherosclerotic cardiovascular disease (ASCVD), standard ASCVD risk prediction scores underestimate risk in populations with immune disorders, particularly women. This review focuses on the ASCVD implications of immune dysregulation due to disorders with varying global prevalence by sex: autoimmune disorders (female predominant), HIV (male-female equivalent), and hepatitis C virus (male predominant). Factors contributing to ASCVD in women with immune disorders, including traditional risk factors, dysregulated innate and adaptive immunity, sex hormones, and treatment modalities, are discussed. Finally, the need to develop new ASCVD risk stratification tools that incorporate variables specific to populations with chronic immune disorders, particularly in women, is emphasized.
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Affiliation(s)
- Caitlin A. Moran
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Lauren F. Collins
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Nour Beydoun
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Puja K. Mehta
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Yetunde Fatade
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Ijeoma Isiadinso
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - Tené T Lewis
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, USA
| | - Brittany Weber
- Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jill Goldstein
- Massachusetts General Hospital, Department of Psychiatry, and Harvard Medical School, Departments of Psychiatry and Medicine, Boston, MA, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Arshed Quyyumi
- Emory University School of Medicine, Department of Medicine, Center for Heart Disease Prevention, Division of Cardiology and Emory Women’s Heart Center, Atlanta, GA, USA
| | - May Y. Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Kehmia Titanji
- Emory University, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA, USA
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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7
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Chalouni M, Wittkop L, Bani-Sadr F, Lacombe K, Esterle L, Gilbert C, Miailhes P, Zucman D, Valantin MA, Brégigeon-Ronot S, Morlat P, Billaud E, Piroth L, Naqvi A, Sogni P, Salmon D. Risk of severe clinical events after sustained virological response following direct-acting antiviral therapy in HIV and hepatitis C virus coinfected participants. HIV Med 2021; 22:791-804. [PMID: 34212476 DOI: 10.1111/hiv.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Sustained virological response (SVR) decreases the risk of hepatitis C virus (HCV)-related events. Nevertheless, a substantial risk of events persists. We estimated incidences and identified factors associated with severe clinical events after SVR following treatment with a direct-acting antiviral (DAA) in HIV/HCV-coinfected patients. METHODS Participants from the ANRS CO13 HEPAVIH were included if they reached SVR. Incidence rates of overall mortality, liver-related events, AIDS-defining events, ischaemic events and non-liver non-AIDS-defining cancers (NLNA) were estimated. Factors associated with the risk of those events were identified using Poisson models adjusted on age at SVR and sex. RESULTS In all, 775 participants were included. Incidence rates (95% confidence interval) of liver-related events, overall mortality, AIDS-defining events, ischaemic events and NLNA cancers per 1000 person-years were 5.9 (3.3-10.3), 22.2 (16.8-29.5), 0.6 (0.1-4.5), 7.3 (4.4-12.2) and 13.7 (9.4-20.0), respectively. For all events, incidence rates were higher in cirrhotic than in non-cirrhotic participants. Cirrhosis, liver stiffness and CD4 count were associated with liver-related events. Factors associated with overall mortality were age, cirrhosis, liver stiffness and gamma-glutamyl transferase (GGT). For ischaemic events and NLNA cancers, associated factors were total cholesterol and CD4 count, respectively. CONCLUSIONS After SVR following a DAA treatment, liver-related and AIDS-defining events were observed less frequently than NLNA cancers. Severity of liver disease was associated with the risk of liver-related events and of overall mortality but not with ischaemic events and NLNA cancers. Factors reflecting HIV infection were associated with NLNA cancers and liver-related events.
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Affiliation(s)
- Mathieu Chalouni
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, Bordeaux, France
| | - Linda Wittkop
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, Bordeaux, France.,Department of Public Health, CHU de Bordeaux, Bordeaux, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - Karine Lacombe
- INSERM Pierre Louis Institute of Epidemiology and Public Health, IPLESP, Sorbonne University, Paris, France.,Infectious Diseases Department, Saint-Antoine Hospital, APHP, Paris, France
| | - Laure Esterle
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, Bordeaux, France
| | - Camille Gilbert
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, Bordeaux, France
| | - Patrick Miailhes
- Department of Infectious and Tropical Diseases, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - David Zucman
- Internal Medicine Unit, Hôpital Foch, Suresnes, France
| | - Marc Antoine Valantin
- Inserm, Department of Infectious Diseases, Pierre Louis Institute of Epidemiology and Public Health, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Sylvie Brégigeon-Ronot
- Clinical Immunohematology Department, Marseille Public University Hospital System (AP-HM), Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Philippe Morlat
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, Bordeaux, France.,Department of Internal Medicine and Infectious Diseases, Saint André Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Eric Billaud
- Infectious Disease Unit, CHU Nantes, CIC 1413 INSERM, COREVIH, Pays de la Loire, Nantes, France
| | - Lionel Piroth
- Infectious Diseases Department, Dijon University Hospital, Dijon, France.,University of Bourgogne-Franche-Comté, Dijon, France
| | - Alissa Naqvi
- Infectious Diseases Department, Nice University Hospital, Archet Hospital, Nice, France
| | - Philippe Sogni
- Hepatology Department, APHP, Cochin Hospital, INSERM U-1223 and ICD, Pasteur Institute, Paris University, Paris, France.,Paris University, Paris, France
| | - Dominique Salmon
- Paris University, Paris, France.,Infectious and Tropical Diseases Department, AP-HP Centre, Cochin Hospital, Hôtel Dieu, Paris, France
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8
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Tan BK, Chalouni M, Ceron DS, Cinaud A, Esterle L, Loko MA, Katlama C, Poizot-Martin I, Neau D, Chas J, Morlat P, Rosenthal E, Lacombe K, Naqvi A, Barange K, Bouchaud O, Gervais A, Lascoux-Combe C, Garipuy D, Alric L, Goujard C, Miailhes P, Aumaitre H, Duvivier C, Simon A, Lopez-Zaragoza JL, Zucman D, Raffi F, Lazaro E, Rey D, Piroth L, Boué F, Gilbert C, Bani-Sadr F, Dabis F, Sogni' P, Wittkop L, Boccara F. Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus. Clin Infect Dis 2021; 72:e215-e223. [PMID: 32686834 DOI: 10.1093/cid/ciaa1014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. METHODS HIV-HCV coinfected patients were enrolled in the Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS) CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. RESULTS At baseline, median age of the study population (N = 1213) was 45.4 (interquartile range [IQR] 42.1-49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9-7.0) years, the incidence was 6.98 (95% confidence interval [CI], 5.19-9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78-6.00) for coronary and/or cerebral events, and 3.17 (2.05-4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06; 95% CI, 1.01-1.12), prior CVD (HR 8.48; 95% CI, 3.14-22.91), high total cholesterol (HR 1.43; 95% CI, 1.11-1.83), high-density lipoprotein cholesterol (HR 0.22; 95% CI, 0.08-0.63), statin use (HR 3.31; 95% CI, 1.31-8.38), and high alcohol intake (HR 3.18; 95% CI, 1.35-7.52) were independently associated with total ASCVD events, whereas undetectable baseline viral load (HR 0.41, 95% CI, 0.18-0.96) was associated with coronary and/or cerebral events. CONCLUSIONS HIV-HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV RNA are essential to control cardiovascular risk.
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Affiliation(s)
- Boun Kim Tan
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Department of Internal Medicine, Hôpital Cochin, Paris, France.,Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Mathieu Chalouni
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Dominique Salmon Ceron
- Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Alexandre Cinaud
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hypertension and Cardiovascular Prevention Unit, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris, France
| | - Laure Esterle
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Marc Arthur Loko
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Christine Katlama
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service des Maladies Infectieuses et Tropicales, Paris, France.,Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France
| | - Isabelle Poizot-Martin
- Assistance Publique des Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Julie Chas
- France Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Philippe Morlat
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Saint-André, Bordeaux, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l'Archet, Nice, France.,Université de Nice-Sophia Antipolis, Nice, France
| | - Karine Lacombe
- Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Alissa Naqvi
- Centre Hospitalier Universitaire de Nice, Service d'Infectiologie, Hôpital l'Archet, Nice, France
| | - Karl Barange
- Centre Hospitalier Universitaire de Toulouse, Service d'Hépatologie, Hôpital Purpan, Toulouse, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Services des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Service de Médecine Interne-Pôle Digestif, Toulouse, France.,Université Toulouse III, UMR 152, IRD, Toulouse, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, Parris, France.,Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France
| | - Patrick Miailhes
- Centre Hospitalier Universitaire de Lyon, Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Lyon, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service des Maladies Infectieuses et Tropicales, Perpignan, France
| | - Claudine Duvivier
- Assistance Publique des Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Jose-Luis Lopez-Zaragoza
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service d'Immunologie Clinique et de Maladies Infectieuses, Créteil, France
| | | | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Department of Infectious Diseases, Nantes, France.,Université de Nantes, CIC 1413, INSERM, Nantes, France
| | - Estibaliz Lazaro
- Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, hôpital Haut-Lévèque, Service de Médecine Interne et Maladies Infectieuses, Pessac, France
| | - David Rey
- Centre Hospitalier Universitaire de Strasbourg, Le Trait d'Union, HIV Infection Care Center, Strasbourg, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d'Infectiologie, Dijon, France.,Université de Bourgogne, Dijon, France
| | - François Boué
- Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Médecine Interne et d'Immunologie clinique, Clamart, France
| | - Camille Gilbert
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Reims, France.,Université Reims Champagne Ardenne, EA-4684/SFR CAP-SANTE, Reims, France
| | - François Dabis
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Philippe Sogni'
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d'Hépatologie, Paris, France.,Inserm U-1223, Institut Pasteur, Paris, France
| | - Linda Wittkop
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Franck Boccara
- Assistance Publique des Hôpitaux de Paris, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Paris University, Paris, France.,National Institute of Health and Medical Research, INSERM, UMR_S 938, UPMC, Paris, France
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9
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Roguljic H, Nincevic V, Bojanic K, Kuna L, Smolic R, Vcev A, Primorac D, Vceva A, Wu GY, Smolic M. Impact of DAA Treatment on Cardiovascular Disease Risk in Chronic HCV Infection: An Update. Front Pharmacol 2021; 12:678546. [PMID: 34045969 PMCID: PMC8144519 DOI: 10.3389/fphar.2021.678546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 12/31/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a systemic disease associated with multiple significant extrahepatic manifestations. Emerging studies indicate association between the HCV infection and a higher incidence of major adverse cardiovascular events such as: coronary artery disease, heart failure, stroke and peripheral artery disease, when compared to general population. Atherosclerosis is a common pathophysiologic mechanism of cardiovascular disease (CVD) development which is the leading cause of mortality in the Western world. Proposed mechanisms of HCV-induced atherosclerosis includes systemic inflammation due to the chronic infection with increased levels of pro-atherogenic cytokines and chemokines. Furthermore, it has been demonstrated that HCV exists and replicates within atheroschlerotic plaques, supporting the theory of direct pro-atherogenic effect of the virus. Direct acting antiviral agents (DAAs) represent a safe and highly effective treatment of HCV infection. Beside the improvement in liver-related outcomes, DAAs exhibit a beneficial effect on extra-hepatic manifestations of chronic HCV infection. Recently, it has been shown that patients with chronic HCV infection treated with DAA-based therapeutic regimes had a 43% reduction of CVD events incidence risk. Moreover, eradication of HCV with DAAs results in a significant positive effect on risk factors for cardiovascular disease, despite a general worsening of the lipid profile. This positive effects is mainly due to an improvement of endothelial function and glucose metabolism. Although DAA treatment is associated with a beneficial impact on cardiovascular events, further studies are needed to fully elucidate the mechanisms responsible.
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Affiliation(s)
- Hrvoje Roguljic
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,University Hospital Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Vjera Nincevic
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Kristina Bojanic
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Health Center Osijek, Osijek, Croatia
| | - Lucija Kuna
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Robert Smolic
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandar Vcev
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,University Hospital Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Dragan Primorac
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,St. Catherine Specialty Hospital, Zabok, Croatia.,Eberly College of Science, The Pennsylvania State University, State College, PA, United States.,The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States.,Medical School, University of Split, Split, Croatia.,Medical School, University of Rijeka, Rijeka, Croatia.,Medical School REGIOMED, Coburg, Germany.,Medical School, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Andrijana Vceva
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,University Hospital Osijek, Osijek, Croatia
| | - George Y Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, United States
| | - Martina Smolic
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
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10
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Butt AA, Yan P, Aslam S, Abou-Samra AB, Sherman KE, Shaikh OS. Liver Fibrosis Progression and Mortality in Hepatitis B- and C-Coinfected Persons Treated With Directly Acting Antiviral Agents: Results From ERCHIVES. Clin Infect Dis 2021; 71:664-666. [PMID: 31840746 DOI: 10.1093/cid/ciz1097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
For persons with baseline Fibrosis-4 1.46-3.25, cirrhosis incidence/1000 patient-years was 49.3 among hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfected and 18.2 among HCV monoinfected (P = .03). Cirrhosis risk was numerically higher but statistically nonsignificant among HBV/HCV coinfected (hazards ratio [HR] 1.51; 95% confidence intervals [CI], .37-6.05) but lower among those who attained sustained virologic response (HR, .52; 95% CI, .42-.63).
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Affiliation(s)
- Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Weill Cornell Medical College, New York, New York, USA, and Doha, Qatar.,Hamad Medical Corporation, Doha, Qatar
| | - Peng Yan
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Samia Aslam
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Abdul-Badi Abou-Samra
- Weill Cornell Medical College, New York, New York, USA, and Doha, Qatar.,Hamad Medical Corporation, Doha, Qatar
| | | | - Obaid S Shaikh
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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11
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Lee KK, Stelzle D, Bing R, Anwar M, Strachan F, Bashir S, Newby DE, Shah JS, Chung MH, Bloomfield GS, Longenecker CT, Bagchi S, Kottilil S, Blach S, Razavi H, Mills PR, Mills NL, McAllister DA, Shah ASV. Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study. Lancet Gastroenterol Hepatol 2019; 4:794-804. [PMID: 31377134 PMCID: PMC6734111 DOI: 10.1016/s2468-1253(19)30227-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without HCV. Two investigators independently reviewed and extracted data from published reports. The main outcome was cardiovascular disease, defined as hospital admission with, or mortality from, acute myocardial infarction or stroke. We calculated the pooled RR of cardiovascular disease associated with HCV using a random-effects model. Additionally, we calculated the population attributable fraction and disability-adjusted life-years (DALYs) from HCV-associated cardiovascular disease at the national, regional, and global level. We also used age-stratified and sex-stratified HCV prevalence estimates and cardiovascular DALYs for 100 countries to estimate country-level burden associated with HCV. This study is registered with PROSPERO, number CRD42018091857. FINDINGS Our search identified 16 639 records, of which 36 studies were included for analysis, including 341 739 people with HCV. The pooled RR for cardiovascular disease was 1·28 (95% CI 1·18-1·39). Globally, 1·5 million (95% CI 0·9-2·1) DALYs per year were lost due to HCV-associated cardiovascular disease. Low-income and middle-income countries had the highest disease burden with south Asian, eastern European, north African, and Middle Eastern regions accounting for two-thirds of all HCV-associated cardiovascular DALYs. INTERPRETATION HCV infection is associated with an increased risk of cardiovascular disease. The global burden of cardiovascular disease associated with HCV infection was responsible for 1·5 million DALYs, with the highest burden in low-income and middle-income countries. FUNDING British Heart Foundation and Wellcome Trust.
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Affiliation(s)
- Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Dominik Stelzle
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mohamed Anwar
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona Strachan
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sophia Bashir
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jasmit S Shah
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | | | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Chris T Longenecker
- Division of Cardiology, University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shashwatee Bagchi
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shyamasundaran Kottilil
- Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Blach
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | - Peter R Mills
- Department of Gastroenterology, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Anoop S V Shah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
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12
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Butt AA, Yan P, Shaikh OS, Abou-Samra AB. Hepatitis B reactivation and outcomes in persons treated with directly acting antiviral agents against hepatitis C virus: results from ERCHIVES. Aliment Pharmacol Ther 2018; 47:412-420. [PMID: 29181838 DOI: 10.1111/apt.14426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/15/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Higher risk of hepatitis B reactivation (HBV-r) has been reported in patients with hepatitis C treated with newer directly acting antiviral agents (DAAs). AIM To determine the proportion of persons who develop HBV-r and its clinical consequences among DAA treated vs pegylated interferon/ribavirin (PEG/RBV) treated persons. METHODS We calculated the proportion of persons who developed HBV viral reactivation (HBV-r; new detectable HBV DNA or increase of >1 log10 ); serum alanine aminotransferase flare (>5 times baseline); all-cause mortality and hepatic decompensation in persons treated with a newer DAA regimen or PEG/RBV. Kaplan-Meier curves were used to demonstrate survival and hepatic decompensation by treatment group and HBV-r. RESULTS In 34 632 persons treated with DAA and 23 475 treated with PEG/RBV, HBV-r rate per 1000 person-years was 30.04 (10.41, 49.67) and 25.42 (95% CI 17.23, 33.62) respectively (P = .8). When stratified by SVR or by baseline HBsAg status, HBV-r was not different between groups. Kaplan-Meier survival curves comparing each regimen stratified by presence or absence of HBV-r did not demonstrate a significant difference in incidence of hepatic decompensation over time. For overall survival, there was no difference between PEG/RBV treated persons with or without HBV-r. For DAA treated persons, those with HBV-r had a shortened survival, though the numbers at risk were small. CONCLUSIONS HBV-r is relatively uncommon after DAA therapy and not higher than among those treated with a PEG/RBV regimen. The small numbers of persons treated with a DAA regimen who do develop HBV-r have a shortened survival compared to those without HBV-r.
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Affiliation(s)
- A A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Weill Cornell Medical College, New York, NY, USA.,Hamad Medical Corporation, Doha, Qatar
| | - P Yan
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - O S Shaikh
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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