Abstract 3271: Use of Protease Inhibitors and Long-term Cocaine Use is Associated with Coronary Stenoses in HIV-Infected Individuals with No Detectable Coronary Calcium
Objectives: The incidence of coronary artery disease (CAD) has increased in HIV-infected patients since the implementation of advanced antiretroviral therapy. CAD may also be present in younger individuals in the absence of coronary artery calcium (CAC). Our study evaluated whether the use of PIs and a history of cocaine use are associated with the presence of a coronary stenosis (> 20% diameter stenosis) on computed tomographic angiography (CTA) in HIV-infected subjects in absence of CAC.
Methods: A total of 109 African-American individuals (25–54 years) infected with HIV and living in the Baltimore area were enrolled between 08/03–02/06 in a study investigating the impact of cocaine use and HIV on atherosclerosis. Those with a history of hypertension or CAD on the basis of clinical history, electrocardiographic or echocardiographic evidence of prior infarction- were excluded from this analysis. CTA with a 64-slice Siemens multi-detector CT scan was performed to detect coronary stenosis and CAC (present in 35 subjects).
Results: A total of 74 subjects (36% females, mean age 42±5 years) had no detectable CAC. The mean cholesterol level was 155±34mg/dl, and 28 individuals were currently taking a PI. On CTA, 8 individuals (11%) had a non-calcified plaque resulting in at least stenosis of ≥20%. Among the variables examined, (age, sex, family history, PI use, cocaine and other illegal drugs use, cholesterol, HDL, LDL, CRP, cigarette smoking, alcohol, glucose, systolic and diastolic BP, BMI, and triglycerides), only HDL, cocaine use, age, and PI use were significantly different between stenosis (+) and stenosis (−) based on the asymptotic t-test. Univariate logistic regression analysis indicated that the duration of PI use was associated with the presence of a coronary stenosis (OR= 1.05 with 95% CI: 1.02–1.09, p= 0.0014). In multivariate analyses, adjusting for significant variables in univariate analyses, long-term cocaine use (OR: 29.3 with 95% CI: 2.39 -∞) and duration of PI use (OR: 1.1 with 95% CI: 1.02–1.104) were independently associated with the presence of a coronary stenosis.
Conclusions: The duration of PI use and long-term cocaine addiction are associated with the presence of a coronary stenosis in HIV-infected subjects despite the absence of CAC.