The Subclinical Change Of The Artherosclerosis Of The African-American Young People With HIV Infection Or Cocaine Use

Purpose: Several methods were used to investigate the effect of HIV infection and/or cocaine use on the early subclinical change of the coronary artery disease in the African-American population in Baltimore, Maryland during the year of 2003 to the year of 2008.Methods: 337 participants without prior CHD or CHD relative manifestation from Baltimore, Maryland of USA, had been interviewed for sociodemographics, drug-use behaviors, had had the tests of lipid profiles and high-sensitivity C-reactive protein, 64 slides CT was used to scan the coronary artery in all the participants and MRI was performed to detect the internal carotid artery vessel in 57 participants. Among these participants, 171 participants who were enrolled related to HIV and cocaine using between May 20, 2003 and May 26, 2005 without prior CHD or CHD relative manifestation from Baltimore, Maryland of USA were estimated the next 10 year CHD risk scores using FRS criteria. Then we used multiple regression analysis to detect the correlations of FRS and CACS in these 171 participants of HIV infectious and/or cocaine use. Among those participants, there were 57 participants who had been performed MRI detection on the internal carotid artery vessel also had been interviewed for sociodemographics, drug-use behaviors, had had tests of lipid profiles and high-sensitivity C-reactive protein and multi-variates linear regression model were used to analyze the correlations of long term cocaine exposure with the carotid artery vessel change. For those 109 patients aged 25 to 54 years who had a history of HIV infection, cocaine use, both, or neither, were performed angiography (CTA) with a 64-sliced multidetector CT scanner to determine the prevalence of noncalcified coronary plaques and stenoses. Subjects without detectable coronary calcium were included in the analysis.Results: For those 171 participants who had calculated the next 10 year CHD risk score using Framingham risk score sheets, the risk scores of HIV+ /cocaine+ group was 3.80±2.54%, had been significantly increased than that of HIV-/cocaine- group, (2.29±1.57%, p= 0.05 ), the risk scores of HIV+/cocaine- group were 4.39±3.76%, were significantly higher than that of HIV-/cocaine- group ( 4.39±3.76% vs 2.29±1.57%, p= 0.02 ), and the risk scores of HIV-/cocaine+ group were 4.44±3.31%, were also significantly higher than that of HIV-/cocaine- group ( 4.44±3.31% vs2.29±1.57%, p=0.001) .The prevalence of any CACS (calcium score >0) was 27.3 % in HIV+/cocaine+ group, 28.6% in HIV-/cocaine+ group, 27.3% in HIV+/cocaine- , all higher than the prevalence of any CACS in HIV-/cocaine- group. Adjusted by the Advanced CACS, the FRS were 6.0±2.37% of HIV+/cocaine+, 5.67±2.42% of HIV-/cocaine+, but none of patients could be calculated FRS of HIV+/cocaine+ and HIV-/cocaine- groups. Considered the coronary calcium as a mono-variable, the odds ratio of calculated 10 year CHD risk were e^0.23=1.26 (95% CI, 1.11～1.43, p=0.03) for total coronary calcium, e^0.06=1.06 (95% CI, 0.89～1.28, p=0.5) for left main coronary calcium, e^0.17=1.18 (95% CI, 1.03～1.34, p=0.01) for left anterior descending artery calcium, e^0.31=1.37 (95% CI, 1.14～1.63, p=0.007) for circumflex artery calcium. Using multiple regression analysis, there were significant correlations of FRS and CACS in present study participants of HIV infectious cocaine using patients. Of the 57 study participants who had had the MRI on the internal carotid vessel, the cocaine user group(n=40) had no significantly but a slightly elevated levels of CRP(5.14±12.31 vs 1.29±0.92, p=0.059), WBC(5.03±1.70 vs 4.12±1.22, p=0.059), no significantly but a slightly lower levels of MCH(29.34±2.18 vs 31.77±4.50 p=0.055), MCHC(33.23±0.75 vs 33.67±0.49, p=0.38) with non-cocaine user group(n=17). There was neither significant difference of the mean thickness of internal carotid vessel(MTICV) between the cocaine users group (0.952±0.244cm) with non-cocaine users group (0.968±0.275 cm, P=0.822), nor significant difference of the percent of MTICV>1.0 cm as the wall being thicken between the two groups (25% of cocaine users vs 29.4% of non cocaine users, P=0.729). Using univariate liner regression model, we found that the horizontal outer contour diameter(HOD), vertical inner lumen diameter(VID), outer area of contour(OA), inner lumen area (ILA), outer volume(OV) and lumen volume(LV) of the internal carotid artery vessel contour had significant negative correlation with cocaine use. The horizontal inner lumen diameter(HID), vertical outer contour diameter(VOD), vertical thickness of vessel wall(VTW), horizontal thickness of the vessel wall(HTW), the thickest vessel wall(TVW) and MTICV had no significant relationship with cocaine using. Multiple-variates linear regression model showed only the cocaine use had significant negative correlation with the HOD, VID, OA, ILA, OV and LV of the internal carotid artery vessel contour while HIV infection, age, gender, BMI and CRP had no significant correlation with the internal carotid artery vessels changes. Of the 109 participants who had had the 64 slides CT scanning on the heart, only 74 patients who had not detectble coronary calcium were enrolled in the study. The mean age of thestudy population was 42.8±5.0 years and 27 (36%) were females. The mean cholesterol level was 155±34 mg/dL. About 11% of individuals without coronary calcification had coronary arterial luminal narrowing of >20% and 7% had a stenosis ≥50%. Of the 74 participants, 60% were cocaine users, and 30% had used the drug for more than 15 years. Thirty-seven percent of the participants had taken PIs. Among the variables examined, only serum HDL concentration, cocaine use, patient age, and PI use were significantly different between patients with and without coronary arterial stenoses. Logistic regression analyses revealed that duration of PI use (OR=1.10) and prolonged (≥15 years) cocaine use (OR=29.6) were independently associated with the presence of coronary arterial stenoses.Conclusion: The results of these methods suggested that HIV infection, cocaine use, alone, both or either may have the effects on the coronary artery, internal carotid artery and the non-calcified coronary arterial plaque. Both of the HIV infection and cocaine useing had the significant correlation with the atherosclerosis in these patients. We also found that in HIV infected patients, long-term cocaine and duration of combination antiretroviral therapy containing PIs may be independently associated with the presence of noncalcified coronary arterial plaques. Since the participants of our study are free of the traditional risk factors, CTA represents a novel technology that can identify subclinical coronary atherosclerosis in these individuals. Improved risk stratification can identify patients who may benefit from a more aggressive cardiovascular prevention strategy.