title: HIV Infection Itself May Not Be Associated With Subclinical Coronary Artery Disease Among African Americans Without Cardiovascular Symptoms.
abstract: BACKGROUND
  The key objectives of this study were to examine whether HIV infection itself is associated with subclinical coronary atherosclerosis and the potential contributions of cocaine use and antiretroviral therapies (ARTs) to subclinical coronary artery disease (CAD) in HIV-infected persons.
  
  
  RESULTS
  Between June 2004 and February 2015, 1429 African American (AA) adults with/without HIV infection in Baltimore, Maryland, were enrolled in an observational study of the effects of HIV infection, exposure to ART, and cocaine use on subclinical CAD. The prevalence of subclinical coronary atherosclerosis was 30.0% in HIV-uninfected and 33.7% in HIV-infected (P=0.17). Stratified analyses revealed that compared to HIV-uninfected, HIV-infected ART naïve were at significantly lower risk for subclinical coronary atherosclerosis, whereas HIV-infected long-term ART users (≥36 months) were at significantly higher risk. Thus, an overall nonsignificant association between subclinical coronary atherosclerosis and HIV was found. Furthermore, compared to those who were ART naïve, long-term ART users (≥36 months) were at significantly higher risk for subclinical coronary atherosclerosis in chronic cocaine users, but not in those who never used cocaine. Cocaine use was independently associated with subclinical coronary atherosclerosis.
  
  
  CONCLUSIONS
  Overall, HIV infection, per se, was not associated with subclinical coronary atherosclerosis in this population. Cocaine use was prevalent in both HIV-infected and -uninfected individuals and itself was associated with subclinical disease. In addition, cocaine significantly elevated the risk for ART-associated subclinical coronary atherosclerosis. Treating cocaine addiction must be a high priority for managing HIV disease and preventing HIV/ART-associated subclinical and clinical CAD in individuals with HIV infection.
authors.affiliation: Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Hong
authors.initials: H
authors.lastname: Lai
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Gary
authors.initials: G
authors.lastname: Gerstenblith
authors.affiliation: Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Glenn
authors.initials: G
authors.lastname: Treisman
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Keruly
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kickler
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Ji
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Shaoguang
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD slai@jhmi.edu.
authors.forename: Shenghan
authors.initials: S
authors.lastname: Lai
authors.affiliation: Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
mesh_terms: D000328:Adult; D001741:Black or African American; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D058070:Asymptomatic Diseases; D015142:Baltimore / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000208:ethnology*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000139:chemically induced / Q000175:diagnosis / Q000208:ethnology*; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents
keywords: African American; HIV infection; antiretroviral therapy; cocaine use; coronary CT angiography; subclinical coronary atherosclerosis