HIV Infection Itself May Not Be Associated With Subclinical Coronary Artery Disease Among African Americans Without Cardiovascular Symptoms

Abstract

Background The key objectives of this study were to examine whether HIV infection itself is associated with subclinical coronary atherosclerosis and the potential contributions of cocaine use and antiretroviral therapies ( ART s) to subclinical coronary artery disease ( CAD ) in HIV ‐infected persons. Methods and Results Between June 2004 and February 2015, 1429 African American ( AA ) adults with/without HIV infection in Baltimore, Maryland, were enrolled in an observational study of the effects of HIV infection, exposure to ART , and cocaine use on subclinical CAD . The prevalence of subclinical coronary atherosclerosis was 30.0% in HIV ‐uninfected and 33.7% in HIV ‐infected ( P =0.17). Stratified analyses revealed that compared to HIV ‐uninfected, HIV ‐infected ART naïve were at significantly lower risk for subclinical coronary atherosclerosis, whereas HIV ‐infected long‐term ART users (≥36 months) were at significantly higher risk. Thus, an overall nonsignificant association between subclinical coronary atherosclerosis and HIV was found. Furthermore, compared to those who were ART naïve, long‐term ART users (≥36 months) were at significantly higher risk for subclinical coronary atherosclerosis in chronic cocaine users, but not in those who never used cocaine. Cocaine use was independently associated with subclinical coronary atherosclerosis. Conclusions Overall, HIV infection, per se, was not associated with subclinical coronary atherosclerosis in this population. Cocaine use was prevalent in both HIV ‐infected and ‐uninfected individuals and itself was associated with subclinical disease. In addition, cocaine significantly elevated the risk for ART ‐associated subclinical coronary atherosclerosis. Treating cocaine addiction must be a high priority for managing HIV disease and preventing HIV / ART ‐associated subclinical and clinical CAD in individuals with HIV infection.

HIV, Cocaine Use, and Hepatitis C Virus

“…This finding supports data from Lai and colleagues, who found strong associations between chronic cocaine use, coronary calcium, and coronary plaque 30, 31 among African American participants. The acute sympathomimetic effects of cocaine use, including myocardial infarction, are well characterized, 32 but evidence also suggests chronic irreversible vascular damage from cocaine use.…”

Coronary Plaque Progression and Regression in Asymptomatic African American Chronic Cocaine Users With Obstructive Coronary Stenoses: A Preliminary Study

“…Cocaine use may not only promote coronary plaque progression, but also triggers/exacerbates adverse cardiovascular comorbidities induced by antiretroviral therapy (ART) [Lai et al, 2016]. …”

“… * Median (interquartile range) for continuous variables, proportion (%) for categorical variables. Abbreviations: BMI, body mass index (kg/m 2 ); hsCRP, high-sensitivity C-reactive protein; BP, blood pressure; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; glucose, fasting glucose; eGFR, estimated glomerular filtration rate; the 2013 risk, cardiovascular risk defined by the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk [22]; low 2013 risk, cardiovascular risk defined by the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk≤7.5% [22]. …”

HIV and Aging – Perhaps Not as Dramatic as We Feared?

“…In recent large CCTA studies from the USA, inconsistent results were recorded, i.e., an increased [11] and a similar [12] prevalence of noncalcified plaque in HIV-positive compared to HIV-negative persons. An increased duration of ART was associated with subclinical atherosclerosis in these studies [11, 12], but individual ART agents were not associated [13], suggesting that achieving and maintaining virological control may be the more important factors. The lower coronary artery disease rates in central/southern Europe compared to North America highlight the need for European studies.…”