HIV Infection Itself May Not Be Associated with Subclinical Coronary Artery Disease among African Americans without Cardiovascular Symptoms

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.

Below:  Prevalences of subclinical CAD by HIV serostatus

Below:  Unadjusted prevalence estimates of subclinical CAD by the 2013 ACC/AHA cardiovascular risk profile quintile

Below:  Associations between HIV infection and presence of coronary stenosis by duration of ART use

Full article at:   http://goo.gl/iwwLdK

By:  Lai H1, Moore R2, Celentano DD3, Gerstenblith G2, Treisman G4, Keruly JC2, Kickler T5, Li J5, Chen S5, Lai S6, Fishman EK1.

• 1Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD.
• 2Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
• 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
• 4Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD.
• 5Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.
• 6Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD slai@jhmi.edu. 
• J Am Heart Assoc. 2016 Mar 24;5(3). pii: e002529. doi: 10.1161/JAHA.115.002529.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health