Abstract P231: Metabolic and Life Style Risk Factors and All-Cause Mortality in the Miami Adult Studies in HIV (MASH) Cohort
Introduction: AIDS-related death rates have declined due to antiretroviral therapy (ART); however, non-AIDS related deaths have proportionally increased.
Hypothesis: Metabolic factors and cocaine use are predictors of mortality in MASH, an HIV infected cohort of adults in Miami.
Methods: We obtained consent and collected anthropometric, demographics, drug, and tobacco use, CD4 cell count and HIV viral load from 487 HIV-infected participants, followed for a median of two years. Death certificates were obtained from the Florida Bureau of Vital Statistics. Cocaine use was obtained from questionnaires and urine toxicology. Obesity and metabolic variables included: BMI>27 kg/m2, waist >88 cm for women and 102 cm for men, plasma glucose >110 mg/dl, systolic blood pressure >130 mmHg. Alcohol use was determined using the Alcohol Use Disorders Identification Test (AUDIT). Sequential stepwise logistic regression models were used to analyze the association between the risk factors and mortality controlling by age, gender, cocaine and alcohol use.
Results: Out of 487 participants, 65% were male, 69% African-Americans, and 81% were on ART. At baseline 31% of the cohort used cocaine, 28% were alcohol dependent, and 64% smoked >20 cigarettes/day. Mean age was 46.8±7.7 years; CD4 count was 501.6±347.3 cells/μl and HIV viral load was 2.9±1.3 log10 copies/ml. BMI >27 was observed in 47% of all participants, central obesity measured by waist circumference was 35%. Hypertension was found in 39% and hyperglycemia in 12%. During the follow-up, 27 patients died, 10 of whom (37%) used cocaine. Of all the variables analyzed, the use of cocaine had the highest risk for mortality (OR = 2.62, 95%CI: (1.01, 6.76), P=0.047). Those with central obesity measured by waist circumference and BMI >27 kg/m2 had higher probability for survival, (OR=2.8, 95% CI:1.01, 7.74, P=0.04) and (OR=2.2, 95%CI:0.92,5.47, P=0.07) respectively.
Conclusions: Cocaine use was a strong predictor of mortality in HIV infected adults, overshadowing factors such as obesity, tobacco and alcohol use and other metabolic variables. Despite existing literature showing that metabolic complications explain in part the emergence of increased cardiovascular morbidity in the HIV population, the results of this study extend ours’ and others’ earlier findings of association between obesity and slower HIV disease progression. Identification of mechanisms for this association is needed.
Author Disclosures: M.K. Baum: None. A. Campa: None. S. Martinez: None. Y. Li: None. P. Greer: None. J. Murillo: None. T. Stewart: None. C. Fleetwood: None. V. Ramamoorthy: None. E. Veledar: None.
- © 2015 by American Heart Association, Inc.