HIV, Cocaine Use, and Hepatitis C Virus: A Triad of Nontraditional Risk Factors for Subclinical Cardiovascular Disease.
We assessed cross-sectional and longitudinal associations of 3 nontraditional cardiovascular disease risk factors-HIV, cocaine use, and chronic hepatitis C virus infection-with 3 validated markers of subclinical cardiovascular disease: carotid artery plaque, albuminuria, and aortic pulse wave velocity in a well-characterized cohort.



We measured carotid plaque at baseline and after 24 months, urine albumin/creatinine ratio every 6 months, and pulse wave velocity annually for up to 36 months in a predominantly black cohort of 292 participants (100 HIV negative and 192 HIV positive). Thirty-nine percent had chronic hepatitis C virus infection and 20%, 28%, and 52% were never, past, and current cocaine users, respectively. Sixteen percent, 47%, and 64% of those with none, 1 or 2, or all 3 nontraditional risk factors had ≥2 abnormal cardiovascular disease risk markers (P=0.001). In fully adjusted models that included all 3 nontraditional risk factors, HIV infection was independently associated with carotid plaque progression (increase in the number of anatomic segments with plaque), albuminuria (albumin-creatinine ratio >30 mg/g), albuminuria progression (doubling of albumin-creatinine ratio from baseline to a value >30 mg/g), and pulse wave velocity. Cocaine use was associated with an ≈3-fold higher odds of carotid plaque at baseline, and hepatitis C virus infection was significantly associated with a higher risk of carotid plaque progression.



These results suggest that HIV infection, cocaine use, and hepatitis C virus infection are important nontraditional risk factors for cardiovascular disease and highlight the need to understand the distinct and overlapping mechanisms of the associations.
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.). glucas@jhmi.edu.
Gregory M
GM
Lucas
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.).
Mohamed G
MG
Atta
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.).
Derek M
DM
Fine
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.).
Allison M
AM
McFall
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.).
Michelle M
MM
Estrella
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.).
Katie
K
Zook
From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (G.M.L., M.G.A., D.M.F., M.M.E., K.Z.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.M.M.); and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S.).
James H
JH
Stein
D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology; D001011:Aorta / Q000503:physiopathology; D058070:Asymptomatic Diseases; D015142:Baltimore / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D063177:Pulse Wave Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D059289:Vascular Stiffness
HIV infections; cocaine; kidney; pulse wave analysis; ultrasonography