Long-term cocaine use and antiretroviral therapy are associated with silent coronary artery disease in African Americans with HIV infection who have no cardiovascular symptoms

Abstract

Long-term use of cocaine (⩾15 years) and antiretroviral therapy (ART) have been implicated in cardiovascular complications. Nevertheless, the individual and combined effects of ART and cocaine use on silent coronary artery disease have not been fully investigated.Methods: Computed tomography coronary angiography was performed for 165 human immunodeficiency virus (HIV)– infected African American study participants aged 25–54 years in Baltimore, Maryland, with contrast-enhanced 64-slice multidetector computed tomography imaging.Result: Significant (⩾50%) coronary stenosis was detected in 24 (15%) of 165 participants. The prevalence of significant stenosis among those who had used cocaine for ⩾15 years and had received ART for ⩾6 months was 42%. Exact logistic regression analysis revealed that long-term cocaine use(adjusted odds ratio, 7.75; 95% confidence interval, 2.26–31.2) and exposure to ART for ⩾6 months(adjusted odds ratio, 4.35; 95% confidence interval, 1.30–16.4) were independently associated with the presence of significant coronary stenosis. In addition, after controlling for confounding factors,both stavudine use for ⩾6 months or combivir use for ⩾6 months were independently associated with the presence of significant coronary stenosis.Conclusions: Long-term exposure to ART may be associated with silent coronary artery disease;however, the magnitude of increased risk associated with ART was much lower than the risk associated with cocaine use or traditional risk factors. Cardiovascular monitoring and aggressive modification of cardiovascular risk factors are essential for reducing the risk of coronary artery disease in HIV-infected individuals. Extensive efforts should also be made to develop effective cocaine use cessation programs for HIV-infected cocaine users.

Figure 1

Prevalence of significant coronary stenosis, by duration of antiretroviral therapy (ART). The prevalences were 6.8% (5 of 74 patients), 5.6% (1 of 18), 27.8% (5 of 18), 25.0% (1 of 4), 23.1% (3 of 13), and 23.7% (9 of 38) among those who had never received ART, those who had received ART for ⩾6 months, those who had received ART for 6–12 months, those who had received ART for 12–18 months, those who had received ART for 18–24 months, and those who had received ART for >24 months, respectively.

Figure 2

Prevalence of significant coronary stenosis, by cocaine use status. The prevalences were 4.8% (1 of 21 patients), 8.1% (7 of 87), and 28.1% (16 of 57) among those who had never used cocaine, those who had used cocaine for ⩾15 years, and who had used cocaine for <15 years, respectively. ART, antiretroviral therapy.

Figure 3

Prevalence of significant coronary stenosis, by durations of cocaine use and antiretroviral (ART) exposure. The prevalences were 1.6% (1 of 61 patients), 14.9% (7 of 47), 16.1% (5 of 31), and 42.3% (11 of 26) among those who had never used cocaine or used it for ⩾15 years and never received ART or received ART for <6 months, those who had never used cocaine or used it for <15 years but received ART for ⩾6 months, those who used cocaine for ⩾15 years and never received ART or received ART for <6 months, and those who had used cocaine for ⩾15 years and received ART fo ⩾6 months, respectively.