| Methods: Our study had four specific aims and utilized data from Strong Memorial Hospital, AIDS Community Health Center, Unity Health and the National Health and Nutrition Examination Survey (NHANES). Aim 1: We compared the TC/HDL-C ratio among subjects with HIV (n=221), HCV (n=194), or HIV/HCV co-infection (n=153) that were not on HIV antiretrovirals. Aim 2: We compared the mean change in the baseline TC/HDL-C ratio after greater than six months of HIV antiretroviral use between HIV (n=132) and HIV/HCV co-infected subjects (n=74). Aim 3: We compared the FRS among subjects with HIV (n=262), HCV (n=181), or HIV/HCV co-infection (n=196). Aim 4: We compared the FRS from our subjects in Aim 3 matched 3:1 on age and sex to subjects from the 2003-2006 NHANES. Multivariate analyses included linear and logistic regressions and adjusted for important demographic and health characteristics identified in the bivariate analyses.;Aim 1: After controlling for age, sex, race, BMI, lipid lowering use, diabetes and drug use, our multivariate linear regression results indicate HCV mono-infected subjects have a significantly lower TC/HDL-C ratio (parameter estimate: -0.56) than HIV mono-infected persons (p=0.0001). The TC/HDL-C ratio is not significantly different between HIV/HCV co-infected and HIV mono-infected persons in multivariate analyses (parameter estimate: -0.26, p=0.09).;Aim 2: After controlling for CD4 cell counts, HIV antiretroviral duration, calendar time, previous exposure to HIV antiretrovirals, dyslipidemia, and pharmacotherapy for dyslipidemia, there is no significant difference in the TC/HDL-C ratio after at least six months of HAART among either the HIV mono-infected, or HIV/HCV co-infected persons, and the difference between groups is not statistically significant.;Aim 3: After controlling for age, sex, pharmacotherapy for dyslipidemia, calendar year, and use of HIV antiretrovirals, the FRS is not significantly different between HIV, HCV and HIV/HCV co-infected persons in multivariate analyses.;Aim 4: After controlling for age, sex, race, ethnicity, BMI, marital status, pharmacotherapy for dyslipidemia and use of HIV antiretrovirals, the 10-year risk of general cardiovascular disease among persons mono-infected with HCV is 7% greater than the risk among their age and sex matched controls (p=0.01), and the 10-year risk is 9% greater among the HIV/HCV co-infected persons compared to their age and sex matched controls (p=0.01). The 10 year risk is not significantly greater among HIV mono-infected persons compared to their controls.;Conclusion: Study results indicate the risk of abnormal lipid profiles are not likely to be statistically lower in persons with HIV/HCV co-infection when compared with persons with HIV mono-infection. Previous studies have reported that in comparison to HIV mono-infection, HIV and HCV co-infection was associated with lower lipids, suggesting a potentially 'protective' effect against cardiovascular disease risk. However, previous studies have primarily analyzed lipids in separate measures, and research has shown the TC/HDL-C ratio is a more sensitive and predictive measure of cardiovascular disease than analyzing lipid profile measurements separately. Thus the risk of cardiovascular disease among persons co-infected with HIV and HCV may be greater than is currently appreciated. Our analyses also suggest that the risk of cardiovascular disease is significantly greater among persons with HCV mono- infection and HIV/HCV co-infection compared to the general population. In particular, our study found persons mono-infected with HCV had statistically lower lipids than persons mono-infected with HIV or co-infected with HIV and HCV but an elevated Framingham Risk Score. Lower lipid profiles in persons mono-infected with HCV or co-infected with HIV and HCV may incorrectly influence clinicians and patients into assuming there is little risk of cardiovascular disease. This incorrect assumption may translate into ignoring other cardiovascular disease risk factors such as hypertension or diabetes. Future studies are needed to further explore the risk of cardiovascular disease in these populations. (Abstract shortened by UMI.). |
