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