Cocaine use may modify HIV/ART-associated myocardial steatosis and hepatic steatosis
Shenghan Lai1, Gary Gerstenblith2, Richard D Moore2
1Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Insights
Cocaine use may worsen protease inhibitor-related fatty liver and heart conditions in HIV-positive African Americans. Reducing cocaine use could help manage these side effects of antiretroviral therapy (ART).
Area of Science:
- Cardiology
- Hepatology
- Infectious Diseases
- Pharmacology
Background:
- Myocardial and hepatic steatosis are potentially more common in HIV-infected individuals undergoing antiretroviral therapy (ART).
- Factors contributing to these conditions, especially in African Americans, require further investigation.
- The interplay between ART, cocaine use, and steatosis needs clarification.
Purpose of the Study:
- Identify risk factors for myocardial and hepatic steatosis in HIV-infected African Americans.
- Determine if ART use is independently linked to steatosis.
- Examine how cocaine use affects the association between ART and steatosis.
Main Methods:
- A cohort of 220 HIV-infected African Americans in Baltimore was studied between June 2010 and December 2013.
- Proton magnetic resonance spectroscopy quantified myocardial and hepatic triglyceride levels.
- Robust regression analysis was used to identify associations, considering sociodemographic, medical, and laboratory data.
Main Results:
- Longer duration of protease inhibitor (PI) use was independently associated with increased myocardial and hepatic triglyceride content.
- This association was significant in cocaine users for both myocardial (p=0.025) and hepatic steatosis.
- The association between PI use and steatosis was not significant in individuals who never used cocaine.
Conclusions:
- Cocaine use may exacerbate PI-induced toxicity, contributing to myocardial and hepatic steatosis in HIV patients.
- Cocaine abstinence or reduced use may mitigate these ART-associated comorbidities.
- Further clinical trials are recommended to investigate the impact of reduced cocaine use on HIV/AIDS-related steatosis.
Background:
It has been recognized that myocardial and hepatic steatosis may be more prevalent in HIV-infected individuals on antiretroviral therapy (ART); however, factors associated with these conditions have not been thoroughly investigated. The goals of this study were (1) to identify the risk factors for myocardial and hepatic steatosis in HIV-infected African Americans (AAs) and explore whether ART use is independently associated with myocardial and hepatic steatosis, and (2) to examine whether and how cocaine use influences any associations of ART use with myocardial and hepatic steatosis.
Methods:
Between June 2010 and December 2013, 220 HIV-infected AAs in Baltimore, Maryland, were enrolled in a study investigating HIV/ART-associated myocardial and hepatic damage. Proton magnetic resonance spectroscopy was performed to quantify myocardial and hepatic triglyceride contents. Sociodemographic, medical and laboratory data were also obtained. Robust regression model was employed to perform primary statistical analysis.
Results:
Robust regression analyses showed that (1) duration of protease inhibitor (PI) use was independently associated with myocardial and hepatic triglyceride contents, (2) duration of PI use was independently associated with myocardial triglyceride in cocaine users (p=0.025), but not in cocaine never-users (p=0.84), and (3) duration of PI use was independently associated with hepatic triglyceride in cocaine users, but not in cocaine never-users (p=0.52).
Conclusions:
Cocaine use may trigger/exacerbate the toxicity of PI in ART-associated myocardial and hepatic steatosis, suggesting that cocaine abstinence/reduced use may retard these ART-associated comorbidities. Clinical trials should be conducted to examine whether reduced cocaine use improves HIV/AIDS-associated myocardial and hepatic steatosis.
Related Concept Videos
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
01:29Stimulants
Cocaine can be administered via snorting, injection, or smoking. It primarily functions by blocking the reuptake of dopamine, resulting in a euphoric high characterized by an intense sensation of happiness and...
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
01:24Drug Toxicity: Risk factors
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test