HIV, Cocaine Use, and Hepatitis C Virus: A Triad of Nontraditional Risk Factors for Subclinical Cardiovascular Disease

Abstract

Objective: We assessed cross-sectional and longitudinal associations of 3 nontraditional cardiovascular disease risk factors-HIV, cocaine use, and chronic hepatitis C virus infection-with 3 validated markers of subclinical cardiovascular disease: carotid artery plaque, albuminuria, and aortic pulse wave velocity in a well-characterized cohort.

Approach and results: We measured carotid plaque at baseline and after 24 months, urine albumin/creatinine ratio every 6 months, and pulse wave velocity annually for up to 36 months in a predominantly black cohort of 292 participants (100 HIV negative and 192 HIV positive). Thirty-nine percent had chronic hepatitis C virus infection and 20%, 28%, and 52% were never, past, and current cocaine users, respectively. Sixteen percent, 47%, and 64% of those with none, 1 or 2, or all 3 nontraditional risk factors had ≥2 abnormal cardiovascular disease risk markers (P=0.001). In fully adjusted models that included all 3 nontraditional risk factors, HIV infection was independently associated with carotid plaque progression (increase in the number of anatomic segments with plaque), albuminuria (albumin-creatinine ratio >30 mg/g), albuminuria progression (doubling of albumin-creatinine ratio from baseline to a value >30 mg/g), and pulse wave velocity. Cocaine use was associated with an ≈3-fold higher odds of carotid plaque at baseline, and hepatitis C virus infection was significantly associated with a higher risk of carotid plaque progression.

Conclusions: These results suggest that HIV infection, cocaine use, and hepatitis C virus infection are important nontraditional risk factors for cardiovascular disease and highlight the need to understand the distinct and overlapping mechanisms of the associations.

Keywords: HIV infections; cocaine; kidney; pulse wave analysis; ultrasonography.

Figure

Bar chart showing percentages of participants with 0, 1, 2, or 3 CVD indicators (carotid plaque, albuminuria, and pulse wave velocity > 9.6 m/s measured at any visit) according to the number of non-traditional risk factors (HIV, cocaine use [past or current], and HCV). The figure includes 276 participants (95%) with at least one valid measure of each CVD indicator). The percentages with 0, 1, 2, and 3 cardiovascular indicators were 20%, 63%, 13%, and 3% in those with no non-traditional risk factors; 22%, 32%, 32%, and 15% in those with 1 or 2 non-traditional risk factors; and 14%, 22%, 43%, and 21% in those with all 3 non-traditional risk factors (P=0.001 for overall difference).