HIV Infection Itself May Not Be Associated With Subclinical Coronary Artery Disease Among African Americans Without
Hong Lai1, Richard Moore2, David D Celentano3
1Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD.
Insights
HIV infection itself does not increase the risk of subclinical coronary atherosclerosis. However, long-term antiretroviral therapy (ART) use and cocaine use are associated with increased risk, especially when combined.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Investigating the link between HIV infection and subclinical coronary atherosclerosis.
- Examining the roles of cocaine use and antiretroviral therapies (ARTs) in cardiovascular disease among HIV-infected individuals.
Purpose of the Study:
- To determine if HIV infection is independently associated with subclinical coronary atherosclerosis.
- To assess the contributions of cocaine use and ARTs to subclinical coronary artery disease (CAD) in HIV-infected persons.
Main Methods:
- An observational study enrolled 1429 African American adults with or without HIV infection.
- Data collected on HIV status, ART exposure, cocaine use, and subclinical coronary atherosclerosis.
- Prevalence and risk stratified by HIV status, ART use duration, and cocaine use.
Main Results:
- Overall prevalence of subclinical coronary atherosclerosis was similar in HIV-uninfected (30.0%) and HIV-infected (33.7%) individuals.
- HIV-infected ART-naïve individuals had lower risk; long-term ART users (≥36 months) had higher risk.
- Cocaine use was independently associated with subclinical CAD and amplified ART-associated risk.
Conclusions:
- HIV infection alone is not linked to subclinical coronary atherosclerosis.
- Cocaine use is a significant risk factor for subclinical CAD, independent of HIV status.
- Addressing cocaine addiction is crucial for preventing cardiovascular complications in people with HIV, particularly those on ART.
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 (ARTs) 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.
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