HIV Infection and Cocaine Use Linked to Early Atherosclerosis

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By Will Boggs, MD

HIV infection and cocaine use may contribute to early subclinical atherosclerotic cardiovascular disease, according to a report in the March 28th Archives of Internal Medicine.

HIV infection and cocaine use have previously been associated with cardiovascular complications, the authors explain, but there is little information on the effects of combined HIV infection and cocaine use on subclinical atherosclerosis.

Dr. Shenghan Lai from The Johns Hopkins Medical Institutions in Baltimore, Maryland, and colleagues studied the association of HIV infection and cocaine use, alone and in combination, with coronary artery calcification, a marker of subclinical atherosclerosis, in 224 subjects aged 25 to 45 years.

Coronary calcification was present in 6 of 32 (18.8%) HIV-negative and cocaine-negative participants, 8 of 28 (28.6%) HIV-positive but cocaine-negative subjects, 14 of 47 (29.8%) of HIV-negative-cocaine-positive individuals, and 32 of 85 (37.6%) who were positive for both HIV and cocaine use, the investigators report.

Among HIV-negative participants, cocaine users had higher total calcified area, total volume, and total calcium score than cocaine nonusers, the report indicates, but none of these differences between cocaine users and nonusers were seen among HIV-positive participants.

Participants who were positive for HIV and cocaine had significantly higher total number of lesions, total calcified area, total volume, and total calcium score than did participants who were negative for both HIV and cocaine use, the researchers note.

Cocaine or HIV positivity alone was associated with significantly more lesions, a larger total calcified area, a higher total volume, and a higher total calcium score, after controlling for other variables, the results indicate.

"HIV infection alone, cocaine use alone, or the two combined may accelerate subclinical atherosclerosis," Dr. Lai told Reuters Health.

"Based on our recent observation, some study participants with significant plaque (calcified or noncalcified) may not have elevated lipid levels," Dr. Lai said. "Thus, in a patient on protease inhibitors who has any risk factor for heart disease (older age, family history, diabetes, etc.), CT coronary angiography might be an option."

04/08/05

Arch Intern Med 2005;165:690-695.