Abstract
BackgroundWe characterized associations between smoking, alcohol, and recreational drug use and coronary plaque by HIV serostatus within the Multicenter AIDS Cohort Study (MACS).MethodsMACS participants (N = 1005, 621 HIV+ and 384 HIV-) underwent non-contrast CT scanning to measure coronary artery calcium; 764 underwent coronary CT angiograms to evaluate plaque type and extent. Self-reported use of alcohol, tobacco, smoked/inhaled cocaine, methamphetamine, ecstasy, marijuana, inhaled nitrites, and erectile dysfunction drugs was obtained at semi-annual visits beginning 10 years prior to CT scanning. Multivariable logistic and linear regression models were performed, stratified by HIV serostatus.ResultsAmong HIV+ men, current smoking, former smoking, and cumulative pack years of smoking were positively associated with multiple coronary plaque measures (coronary artery calcium presence and extent, total plaque presence and extent, calcified plaque presence, and stenosis >50%). Smoking was significantly associated with fewer plaque measures of comparable effect size among HIV- men; current smoking and calcified plaque extent was the only such association. Heavy alcohol use (>14 drinks/week) was associated with stenosis >50% among HIV+ men. Among HIV- men, low/moderate (1–14 drinks/week) and heavy alcohol use were inversely associated with coronary artery calcium and calcified plaque extent. Few significant associations between other recreational drug use and plaque measures were observed.ConclusionSmoking is strongly associated with coronary plaque among HIV+ men, underscoring the value of smoking cessation for HIV+ persons. Alcohol use may protect against coronary artery calcium and calcified plaque progression in HIV- (but not HIV+) men. Few positive associations were observed between recreational drug use and coronary plaque measures.
Highlights
Among human immunodeficiency virus (HIV)+ men, current smoking, former smoking, and cumulative pack years of smoking were positively associated with multiple coronary plaque measures
Among HIV- men, low/moderate (1–14 drinks/week) and heavy alcohol use were inversely associated with coronary artery calcium and calcified plaque extent
Alcohol use may protect against coronary artery calcium and calcified plaque progression in HIV- men
Summary
As survival among human immunodeficiency virus (HIV)-infected persons has been markedly extended through the routine use of potent combination antiretroviral therapy (cART) [1], non-infectious chronic diseases associated with aging in the general population are more prevalent. Multiple studies suggest an increased risk of coronary vascular disease (CVD) among HIV+ persons compared to the general population despite cART-associated HIV viral suppression [2,3,4,5]. Non-calcified plaque, which is lipid-rich, strongly pro-inflammatory, prone to rupture and thrombosis, and carries a high risk of major coronary events, has previously been associated with HIV infection using CT angiography [13,14]. We characterized associations between smoking, alcohol, and recreational drug use and coronary plaque by HIV serostatus within the Multicenter AIDS Cohort Study (MACS)
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