Cardiovascular risk factors and illicit drug use may have a more profound effect on coronary atherosclerosis progression in people living with HIV
- 3 March 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 31 (5), 2756-2767
- https://doi.org/10.1007/s00330-021-07755-7
Abstract
Objectives To assess whether HIV infection directly or indirectly promotes coronary artery disease (CAD) volume progression in a longitudinal study of African Americans. Methods We randomly selected 300 individuals with subclinical CAD (210 male; age: 48.0 ± 7.2 years; 226 HIV infected, 174 cocaine users) from 1429 cardiovascularly asymptomatic participants of a prospective epidemiological study between May 2004 and August 2015. Individuals underwent coronary CT angiography at two time points (mean follow-up: 4.0 ± 2.3 years). We quantified noncalcified (NCP: −100–350HU), low-attenuation noncalcified (LA-NCP: −100-30HU), and calcified (CP: ≥ 351 HU) plaque volumes. Linear mixed models were used to assess the effects of HIV infection, atherosclerotic cardiovascular disease (ASCVD) risk, and years of cocaine use on plaque volumes. Results There was no significant difference in annual progression rates between HIV-infected and HIV-uninfected regarding NCP (8.7 [IQR: 3.0–19.4] mm3/year vs. 4.9 [IQR: 1.5–18.3] mm3/year, p = 0.14), LA-NCP (0.2 [IQR: 0.0–1.6] mm3/year vs. 0.2 [IQR: 0.0–0.9] mm3/year, p = 0.07) or CP volumes (0.3 [IQR: 0.0–3.4] mm3/year vs. 0.1 [IQR: 0.0–3.2] mm3/year, p = 0.30). Multivariately, HIV infection was not associated with NCP (−6.9mm3, CI: [−32.8–19.0], p = 0.60), LA-NCP (−0.1mm3, CI: [−2.6–2.4], p = 0.92), or CP volumes (−0.3mm3, CI: [−9.3–8.6], p = 0.96). However, each percentage of ASCVD and each year of cocaine use significantly increased total, NCP, and CP volumes among HIV-infected individuals, but not among HIV-uninfected. Importantly, none of the HIV-associated medications had any effect on plaque volumes (p > 0.05 for all). Conclusions The more profound adverse effect of risk factors in HIV-infected individuals may explain the accelerated progression of CAD in these people, as HIV infection was not independently associated with any coronary plaque volume. Key Points • Human immunodeficiency virus–infected individuals may have similar subclinical coronary artery disease, as the infection is not independently associated with coronary plaque volumes. • However, cardiovascular risk factors and illicit drug use may have a more profound effect on atherosclerosis progression in those with human immunodeficiency virus infection, which may explain the accelerated progression of CAD in these people. • Nevertheless, through rigorous prevention and abstinence from illicit drugs, these individuals may experience similar cardiovascular outcomes as -uninfected individuals.Funding Information
- National Institute on Drug Abuse (R01DA12777, R01DA15020, R01DA25524, U01DA040325, R21DA048780)
This publication has 24 references indexed in Scilit:
- Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to CareJAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
- Population-Based Estimates of Life Expectancy After HIV DiagnosisJAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
- HIV Infection Itself May Not Be Associated With Subclinical Coronary Artery Disease Among African Americans Without Cardiovascular SymptomsJournal of the American Heart Association, 2016
- Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trialThe Lancet HIV, 2015
- Associations Between HIV Infection and Subclinical Coronary AtherosclerosisAnnals of Internal Medicine, 2014
- Substance Use Among HIV-Infected Patients Engaged in Primary Care in the United States: Findings From the Centers for AIDS Research Network of Integrated Clinical Systems CohortAmerican Journal of Public Health, 2013
- Serial Coronary CT Angiography–Verified Changes in Plaque Characteristics as an End Point: Evaluation of Effect of Statin InterventionJACC: Cardiovascular Imaging, 2010
- Long-Term Control of HIV byCCR5Delta32/Delta32 Stem-Cell TransplantationThe New England Journal of Medicine, 2009
- Long-Term Cocaine Use and Antiretroviral Therapy Are Associated with Silent Coronary Artery Disease in African Americans with HIV Infection Who Have No Cardiovascular SymptomsClinical Infectious Diseases, 2008
- Accelerated Longitudinal Decline of Aerobic Capacity in Healthy Older AdultsCirculation, 2005