HCV, HIV co-infection linked to increased diabetes risk

Treatment guidelines must expand to focus on patients co-infected with both HCV and HIV.
Treatment guidelines must expand to focus on patients co-infected with both HCV and HIV.

Physicians caring for patients with hepatitis and human immunodeficiency virus (HIV) should be aware that these conditions could have an effect on the patient's risk for diabetes and related issues.

A study presented at the American College of Cardiology's 65th Annual Scientific Session by study author Avnish Tripathi, MD, PHD, who is a cardiology fellow at the University of Louisville, Louisville, Kentucky, underscores the concept that "there is no one–size-fits-all.  Care has to be individualized,” he explained.

In an interview with Infectious Disease Advisor, Dr Tripathi said there are not a lot of published data on the development of cardiometabolic diseases in patients co-infected with HCV and HIV. Dr Tripathi and his colleagues evaluated the effect of HCV co-infection on the incidence of diabetes (DM), dyslipidemia, and major adverse cardiac events (MACE) in a population-based cohort of patients with HIV and those who did not have HIV.

The researchers divided the cohort into 4 comparative groups (HIV + HCV; HIV-only; HCV-only and non-infected group). There were 13,632 patients included and the median age was 39 years.  The cohort was 57% male and 71% African American. All the participants were >18 years old and were served through the South Carolina Medicaid during 1994 – 2011.

When compared with the non-infected control group, the HIV-only group was at lower risk of developing DM (adjusted hazards ratio =0.82) and at higher risk of developing dyslipidemia (aHR=1.25). The study demonstrated no significant risks in the HIV+HCV and HCV-only groups.The risk of MACE was found to be higher in HIV+HCV (aHR 1.20) and HIV-only group (aHR=1.19).  However, no elevated risk was found for the HCV only group.

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

“This is a significant problem and in these patients it becomes a different game,” Dr. Tripathi said in an interview.“The risk factors are different and so physicians 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's been conducting research in this field for several years. He agrees with DrTripathi 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, who is an Assistant Professor of Medicine, Case Western Reserve University, Cleveland, Ohio.

He said the current findings with MACE are consistent with prior studies. However, he said this study has some limitations. Dr Longenecker said 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 co-variants 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.

Reference

  1. Tripathi A, Jerrell JM, Saraswat A, et al. 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 the 65th Annual American College of Cardiology Scientific Sessions & Expo. April 2-4, 2016; Chicago, IL.
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