Skip to main content
SpringerLink
Log in

Cardiovascular risk factors and illicit drug use may have a more profound effect on coronary atherosclerosis progression in people living with HIV

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ART:

Antiretroviral therapy

ASCVD:

Atherosclerotic cardiovascular disease

CAD:

Coronary artery disease

CTA:

CT angiography

HIV:

Human immunodeficiency virus

hsCRP:

High-sensitivity C-reactive protein

HU:

Hounsfield unit

IQR:

25th and 75th percentile

NNRTI:

Non-nucleoside reverse-transcriptase inhibitor

NRTI:

Nucleoside reverse-transcriptase inhibitor

PI:

Protease inhibitor

PLVH:

People living with HIV

References

  1. Hutter G, Nowak D, Mossner M et al (2009) Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation. N Engl J Med 360:692–698

    Article  Google Scholar 

  2. Gupta RK, Abdul-Jawad S, McCoy LE et al (2019) HIV-1 remission following CCR5Delta32/Delta32 haematopoietic stem-cell transplantation. Nature 568:244–248

    Article  CAS  Google Scholar 

  3. Marcus JL, Chao CR, Leyden WA et al (2016) Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. J Acquir Immune Defic Syndr 73:39–46

    Article  Google Scholar 

  4. Siddiqi AE, Hall HI, Hu X, Song R (2016) Population-based estimates of life expectancy after HIV diagnosis: United States 2008-2011. J Acquir Immune Defic Syndr 72:230–236

    Article  Google Scholar 

  5. Antiretroviral Therapy Cohort C (2017) Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 4:e349–e356

    Article  Google Scholar 

  6. Lacson JC, Barnes RP, Bahrami H (2017) Coronary artery disease in HIV-infected patients: downside of living longer. Curr Atheroscler Rep 19:18

    Article  Google Scholar 

  7. Post WS, Budoff M, Kingsley L et al (2014) Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med 160:458–467

    Article  Google Scholar 

  8. Bahrami H, Budoff M, Haberlen SA et al (2016) Inflammatory markers associated with subclinical coronary artery disease: the Multicenter AIDS Cohort Study. J Am Heart Assoc 5(6):e003371

  9. Lai H, Moore R, Celentano DD et al (2016) HIV infection itself may not be associated with subclinical coronary artery disease among African Americans without cardiovascular symptoms. J Am Heart Assoc 5:e002529

    Article  Google Scholar 

  10. Tarr PE, Ledergerber B, Calmy A et al (2018) Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. Eur Heart J 39:2147–2154

    Article  CAS  Google Scholar 

  11. Hsue PY, Waters DD (2019) HIV infection and coronary heart disease: mechanisms and management. Nat Rev Cardiol 16:745–759

    Article  Google Scholar 

  12. Lu MT, Meyersohn NM, Mayrhofer T et al (2018) Central core laboratory versus site interpretation of coronary CT angiography: agreement and association with cardiovascular events in the PROMISE Trial. Radiology 287:87–95

    Article  Google Scholar 

  13. Centers for Disease Control and Prevention (2020) Estimated HIV incidence and prevalence in the United States, 2014–2018. HIV Surveillance Supplemental Report 25(1). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 2020.08.01

  14. Chang HJ, Lin FY, Lee SE et al (2018) Coronary atherosclerotic precursors of acute coronary syndromes. J Am Coll Cardiol 71:2511–2522

    Article  Google Scholar 

  15. Deseive S, Straub R, Kupke M et al (2018) Quantification of coronary low-attenuation plaque volume for long-term prediction of cardiac events and reclassification of patients. J Cardiovasc Comput Tomogr 12:118–124

    Article  CAS  Google Scholar 

  16. Lai S, Fishman EK, Lai H et al (2008) 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. Clin Infect Dis 46:600–610

    Article  CAS  Google Scholar 

  17. Ahmadi A, Argulian E, Leipsic J, Newby DE, Narula J (2019) From subclinical atherosclerosis to plaque progression and acute coronary events: JACC State-of-the-Art Review. J Am Coll Cardiol 74:1608–1617

    Article  Google Scholar 

  18. Investigators S-H, Newby DE, Adamson PD et al (2018) Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med 379:924–933

    Article  Google Scholar 

  19. Inoue K, Motoyama S, Sarai M et al (2010) Serial coronary CT angiography-verified changes in plaque characteristics as an end point: evaluation of effect of statin intervention. JACC Cardiovasc Imaging 3:691–698

    Article  Google Scholar 

  20. Verbeke G, Molenberghs G (2000) Linear mixed models for longitudinal data. Springer, New York

    Google Scholar 

  21. Fleg JL, Morrell CH, Bos AG et al (2005) Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 112:674–682

    Article  Google Scholar 

  22. R Core Team (2017) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/. Accessed 2020.08.01

  23. Grinspoon SK, Fitch KV, Overton ET et al (2019) Rationale and design of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE). Am Heart J 212:23–35

    Article  Google Scholar 

  24. Lo J, Lu MT, Ihenachor EJ et al (2015) 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 trial. Lancet HIV 2:e52–e63

    Article  Google Scholar 

  25. Hoffmann U, Lu MT, Olalere D et al (2019) Rationale and design of the Mechanistic Substudy of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE): effects of pitavastatin on coronary artery disease and inflammatory biomarkers. Am Heart J 212:1–12

    Article  CAS  Google Scholar 

  26. Mimiaga MJ, Reisner SL, Grasso C et al (2013) 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 cohort. Am J Public Health 103:1457–1467

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from the US National Institute on Drug Abuse, National Institutes of Health (NIH R01DA12777, R01DA15020, R01DA25524, R21DA048780, and U01DA040325)

Funding

This study has received funding by Shenghan Lai.

Author information

Authors and Affiliations

  1. Department of Pathology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA

    Márton Kolossváry, Thomas S. Kickler, Sarah Bazr, Shaoguang Chen & Shenghan Lai

  2. MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor str, Budapest, 1122, Hungary

    Márton Kolossváry

  3. Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA

    Elliot K. Fishman, Shenghan Lai & Hong Lai

  4. Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA

    Gary Gerstenblith & Shenghan Lai

  5. University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA

    David A Bluemke

  6. National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, 10 Center Dr, Bethesda, MD, 20814, USA

    Raul N. Mandler

  7. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 614 Wolfe N Wolfe St, Baltimore, MD, 21205, USA

    David Celentano & Shenghan Lai

  8. Institute of Human Virology, University of Maryland School of Medicine, W Lombard Street, Baltimore, MD, 21201, USA

    Shaoguang Chen, Shenghan Lai & Hong Lai

  9. Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD, 21201, USA

    Shenghan Lai & Hong Lai

Authors
  1. Márton Kolossváry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elliot K. Fishman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gary Gerstenblith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David A Bluemke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raul N. Mandler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Celentano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas S. Kickler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sarah Bazr
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shaoguang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shenghan Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hong Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shenghan Lai.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Shenghan Lai.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Marton Kolossvary) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board at Johns Hopkins School of Medicine approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in JAHA (Lai H, Moore R, Celentano DD, et al. HIV Infection Itself May Not Be Associated With Subclinical Coronary Artery Disease Among African Americans Without Cardiovascular Symptoms. J Am Heart Assoc. 2016;5(3):e002529. Published 2016 Mar 24. doi:10.1161/JAHA.115.002529).

Methodology

• prospective

• observational

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 74 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kolossváry, M., Fishman, E.K., Gerstenblith, G. et al. Cardiovascular risk factors and illicit drug use may have a more profound effect on coronary atherosclerosis progression in people living with HIV. Eur Radiol 31, 2756–2767 (2021). https://doi.org/10.1007/s00330-021-07755-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-07755-7

Keywords

Search

Navigation