2253. Comparison of Cardiovascular Risk in Patients Infected With HIV and Hepatitis C

Abstract

BackgroundHIV and hepatitis C virus (HCV) are independently associated with poorer cardiovascular and metabolic outcomes compared with the general population. Evidence remains mixed on how these contribute to cardiovascular disease (CVD) risk in co-infection. Prior studies mainly studied established risk models in mono-infected groups or lacked recent scores like Pooled Cohort Equations. This study assesses CVD risk using established risk models and statin usage for primary prevention in matched co-infected and mono-infected cohorts. MethodsRetrospective chart review of HIV and/or HCV-infected subjects = 18 years seen from January 1, 2014 to December 31, 2016 at Washington University Infectious Disease or Hepatology clinics. Patients included if lipid panel available before statin usage and excluded for prior CVD. Patients matched by gender, age, and race/ethnicity. CVD risk assessed with Framingham general CV Risk Score (FRS), ACC/AHA Pooled Cohort equations (PCEs), and Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) HIV model. Multivariate linear models evaluated CVD risk after log-transforming skewed data. ResultsEach infection group (HIV, HCV, HIV/HCV) had 192 matched subjects. Most were male (76.7%) and African American (73.7%) with overall mean age of 51.2 ± 8.6 years. CVD risk did not differ among infection groups with PCE, FRS, and D:A:D models. PCE predicted the most patients in its highest risk group followed by FRS and then D:A:D. Primary prevention statin use was lower in HIV cohorts but higher in patients with diabetes and dyslipidemia. ConclusionCVD risk scores did not differ among HIV/HCV co-infected and respective mono-infected cohorts. CVD risk may be underestimated as specific HIV and HCV-related factors may not be fully captured in these scores. Statin uptake remains low in HIV patients despite recent primary prevention guidelines.Table 1:Coefficients (95% CI) by Log10-Transformed Risk Score ModelCo-infectedHCVHIV P ValuePCERef−0.02 (−0.14, 0.10)−0.07 (−0.17, 0.04)0.52FRSRef0.10 (0.01, 0.20)0.03 (−0.07, 0.13)0.11D:A:DRefN/A0.05 (−0.06, 0.16)0.36Figure 1:(a–c) Ten year CVD risk models across infection group based on model specific definitions of risk cutoff. D:A:D distribution extrapolated from 5-year risk score assuming constant risk over 10 years for ease of comparison.Disclosures All authors: No reported disclosures.