Hepatitis C increases acute myocardial infarction risk in people living with HIV: A systematic review and meta-analysis

Background Hepatitis C virus (HCV) coinfection is common among people living with HIV (PLWH) and is associated with adverse outcomes. However, the specific association between HCV coinfection and the risk of acute myocardial infarction (AMI) in PLWH remains unclear. This systematic review and meta-analysis aims to clarify this relationship. Method We searched MEDLINE and EMBASE databases from inception to October 2024 for cohort studies comparing the incidence of AMI in PLWH with HCV coinfection versus PLWH without HCV coinfection (HIV mono-infection). We used the generic inverse variance method with a random-effects model to pool risk ratios (RRs) and 95% confidence intervals (CIs). Heterogeneity was assessed using the I 2 statistic. All statistical analyses were performed using Review Manager 5.4. Results Seven cohort studies, encompassing 94,664 participants (mean age 42 years, 83% male), met the inclusion criteria. HCV coinfection was associated with a significantly increased risk of AMI in PLWH (pooled RR = 1.25, 95% CI: 1.09, 1.44; I 2 = 18%; p < .001) compared to HIV mono-infection. A subgroup analysis restricted to type 1 AMI was not statistically significant (pooled RR = 1.03, 95% CI: 0.84, 1.26; p = .78). Conclusions HCV coinfection is associated with a significantly increased risk of AMI in PLWH. Further research is needed to determine the pathophysiology of this relationship.