Hepatitis C – Human Immunodeficiency Virus Coinfection and the Risk of Cerebro-Cardiovascular Diseases: Is There Enough Evidence to Draw Conclusion and Establish Guideline?

with diabetes prevalence more than 20%. The pooled OR for cerebrocardiovascular events in setting with low prevalence of diabetes was OR 1.00 95% CI 0.72-1.40, p=1.00. Similarly, pooled OR for carotid atherosclerosis was not signifi cant in setting with low prevalence (<20%) of smoking OR 1.07 95% CI 0.57-2.01, p=0 .84. This refl ect the need to control traditional risk factors among HCV-HIV coinfected patients despite the fact that coinfection probably increase the risk of CVD. The treatment protocol for HCV-HIV coinfection management to prevent CVD is still limited. In 2013, ACC-AHA guideline stated that 74% HIV with high-risk plague did not receive statin therapy. Lifestyle modifi cation also play important role to decrease risk of CVD among PLHIV. Smoking cessation estimated to lower CVD risk by 42%. This lifestyle intervention should be emphasized as lipodystrophy in PLHIV receiving ART tend to has adverse metabolic consequences that favour CVD. Meanwhile, such interventions still lacked of evidence from randomized controlled trials as stated by Nou et al. [2]. The evidence to support treatment fot PLHIV regarding CVD risk is needed. PLHIV with CVD faced increase rate of hospitalization for recurrent coronary event, restenosis and percutaneous revascularization post percutaneous coronary intervention (PCI) [3]. Moreover, HCV-HIV coinfection should take into account in future guideline. Current predictor of CVD among PLHIV also did not include newer evidence about HCV coinfection as potential predictors of CVD [10]. Study by Chew et al showed that antiviral treatment for HCV infection lower liver complications and specifi cally lower systemic infl ammation based on CVD biomarkers [11]. Currently, promoting lifestyle changes among HCV-HIV coinfection patients seems the most effective and benefi cial way despite lack of specifi c guidelines. Physicians could start statin therapy for those with multiple risks of cerebro-cardiovascular diseases. However, further evidence was needed, especially good quality randomized controlled trials recruiting HCV-HIV coinfection patients which evaluate cerebro-cardiovascular diseases as outcomes.