HIV, Cocaine Use, and Hepatitis C Virus

Abstract

Objective We assessed cross-sectional and longitudinal associations of 3 non-traditional cardiovascular disease (CVD) risk factors - human immunodeficiency virus (HIV), cocaine use, and chronic hepatitis C virus (HCV) infection - with 3 validated markers of subclinical CVD: carotid artery plaque, albuminuria, and aortic pulse wave velocity (PWV) in a well-characterized cohort. Approach and Results We measured carotid plaque at baseline and after 24 months, urine albumin-creatinine ratio (ACR) every 6 months, and PWV annually for up to 36 months in a predominantly African-American cohort of 292 participants (100 HIV-negative and 192 HIV-positive). Thirty-nine percent had chronic HCV 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 non-traditional risk factors had ≥2 abnormal CVD risk markers (P=0.001). In fully adjusted models that included all 3 non-traditional risk factors, HIV infection was independently associated with carotid plaque progression (increase in the number of anatomic segments with plaque), albuminuria (ACR >30mg/g), albuminuria progression (doubling of ACR from baseline to a value >30mg/g), and PWV. Cocaine use was associated with an approximately 3-fold higher odds of carotid plaque at baseline and HCV infection was significantly associated with a higher risk of carotid plaque progression. Conclusions These results suggest that HIV infection, cocaine use, and HCV infection are important non-traditional risk factors for CVD and highlight the need to understand the distinct and overlapping mechanisms of the associations.

Acute and Chronic Effects of Cocaine on Cardiovascular Health

“…Lai et al [95,96,97] also showed this association in their earlier studies. Similarly, Lucas et al [92] found greater carotid plaque formation at baseline among cocaine users compared with cocaine nonusers. This variability in findings across studies regarding association between cocaine use and subclinical CAD might be explained by different CAD risk factor profiles of the study populations.…”

“…Chronic cocaine users were at significantly higher risk for the presence of CAC (propensity score-adjusted PR = 1.26, 95% CI: 1.05–1.52), any coronary stenosis (propensity score-adjusted PR = 1.30, 95% CI: 1.08–1.57), and calcified plaques (propensity score-adjusted PR = 1.37, 95% CI: 1.10–1.71), in addition to subclinical CAD. Another study conducted by Lucas et al [92] showed a significant association between cocaine use and carotid plaque formation. More than 90% of subjects in this study were African Americans.…”

“…This variability in findings across studies regarding association between cocaine use and subclinical CAD might be explained by different CAD risk factor profiles of the study populations. The studies reporting cocaine-associated plaques included predominantly African American participants, of whom 40% to 100% were HIV-positive [91,92,100,101,102]. In contrast, all other studies showing no association between cocaine use and coronary calcifications did not include any HIV-positive individuals [84,88,89,90].…”

Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

“…Illicit drug use is associated with a myriad of health conditions, including human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), heart disease, liver disease, soft tissue infections, hypertension, and depression(Centers for Disease Control and Prevention (CDC), 2001; Chen, Huang, Yeh, & Chien, 2015; Coughlin & Shang, 2011; D C Des Jarlais et al, 2007; Doherty et al, 1996; Kessler et al, 1996; Lucas et al, 2016; Stein, 1999; Walker, Pratt, Schoenborn, & Druss, 2016)). Despite being at increased risk for several co-morbidities, people who use drugs (PWUDs), compared with the general population, are more likely to delay seeking medical care when necessary, are less likely to utilize primary medical care and are more likely to utilize emergency rooms as their primary source of care (Chen et al, 2015; Chitwood, McBride, French, & Comerford, 1999; French, McGeary, Chitwood, & McCoy, 2000; McGeary & French, 2000).…”

Imaging to End Points

“…In addition, 25% of the HIV subjects had a history of cocaine exposure compared to only 4% of controls, and hepatitis C infection was present in 18% of the HIV subjects. Non-traditional risk factors for atherosclerotic disease such as cocaine and chronic hepatitis C infection are associated with carotid plaque in HIV 8 . Further, chronic cocaine use was associated with a 2-fold increased risk of coronary artery plaque in HIV, independent of traditional risk factors and ART exposure 9 .…”