Co-Infection With HCV, HIV May Raise Diabetes Risk

Co-infection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) appears to increase the risk for diabetes and decreased the risk for dyslipidemia. However, HCV co-infection does not appear to increase the risk for major adverse cardiac events (MACE) in patients with HIV.

“They have different risk factors,” said study author Avnish Tripathi, MD, PhD, a cardiology fellow at the University of Louisville in Kentucky. “There is no one–size-fits-all. Care has to be individualized.”

The results of Dr Tripathi’s study were presented at the American College of Cardiology’s (ACC) 65th Scientific Sessions in Chicago.

There is a lack of published data on development of cardiometabolic diseases in patients co-infected with HCV and HIV, according to Dr Tripathi. Therefore he and his colleagues sought to evaluate the impact of HCV co-infection with incidence of diabetes, dyslipidemia, and MACE in a population-based cohort of patients with and without HIV.

The researchers divided the cohort into 4 comparative groups: those with HIV only; those with HCV only, and those without either disease. The study included 13 632 patients with a median age of 39 years. The cohort was 57% men and 71% African American. All the subjects were aged at least 18 years and were served through the South Carolina Medicaid during 1994 to 2011.

Compared with the control group, the HIV-only group had a lower risk for developing diabetes (adjusted hazard ratio [HR]=0.82) and a higher risk for developing dyslipidemia (adjusted HR=1.25). The study demonstrated no significant risks in the groups with both HIV and HCV and the HCV-only groups. The risk for MACE was found to be higher in the group co-infected with HIV and HCV (adjusted HR=1.20) and the HIV-only group (adjusted HR=1.19). However, no elevated risk was found for those infected with HCV only.

The investigators also conducted a subgroup analysis that included those co-infected with HCV and HIV and those with HIV only. In this subgroup, they found that after controlling for immunological status and use of antiretroviral medications, HCV co-infection was associated with increased risk for diabetes (adjusted HR=1.52)  and decreased risk for dyslipidemia (adjusted HR=0.60). Dr Tripathi said no significant difference was seen in MACE in the subgroup analysis.

“Endocrinologists need to care about this because this is a significant problem and in these patients it becomes a different game,” Dr. Tripathi told Endocrinology Advisor. “The risk factors are different and so endocrinologists should monitor these patients. You need to be cognizant of testing more often and monitoring them closely and treating them as individuals instead of according to the guidelines.” 

Chris Longenecker, MD, runs an HIV cardiometabolic risk clinic as a preventive cardiologist at University Hospitals in Cleveland. He has been conducting research in this field for several years and agrees with Dr Tripathi that there are no guidelines for patients with these co-infections. However, he said medical organizations/societies are working on changing that.

“There are guidelines that have emerged for HIV infection, but none for co-infections with hepatitis C. There may be guidelines in the near future, and the organizations see this is as an emerging issue, and there will be some organizations coming out with guidelines in the next couple years,” said Dr Longenecker, assistant professor of medicine at Case Western Reserve University in Cleveland, Ohio.

He said the current findings with MACE are consistent with prior studies. However, he noted this study has some limitations. For instance, there may have been significant risk factors that the investigators may not have been able to include in the analysis.  

“It is unclear what information about covariants is missing. There are potential variables with co-infected HIV patients, and you need to consider diet, daily physical activity, and socioeconomics. There are different types of poverty, and some involve access to healthy foods, and it is not clear if they adjusted for these types of risk factors,” Dr Longenecker said in an interview with Endocrinology Advisor.

Reference

1. Tripathi A, Jerrell JM, Saraswat A, Khan A, Hirsch G, Mehta J. Impact of HCV Infection on Development of Cardio-Metabolic Disorders and Major Adverse Cardiac Events in a Population-Based Cohort of HIV-Infected and Non-HIV-Infected Adults. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.