Background: HIV infection is associated with subclinical atherosclerosis. Recreational substance use is prevalent among HIV-infected (HIV+) persons. Associations between substance use and coronary plaque by HIV serostatus are not well-characterized.
Methods: We studied 1005 men who have sex with men in the Multicenter AIDS Cohort Study (612 HIV+ and 384 HIV-uninfected [HIV-]), all of whom had non-contrast CT scanning to measure coronary artery calcium (CAC) and 764 had coronary CT angiograms. Self-reported recreational substance use, including alcohol (ETOH), tobacco, stimulants, marijuana, inhaled nitrites, and drugs to treat erectile dysfunction (EDD) was obtained at each semiannual visit beginning 10 years prior. Logistic (for plaque presence) and linear (for log-transformed plaque scores if >0) regression models were performed stratified by HIV serostatus and adjusted for age, race, education, cardiovascular disease risk factors and, for HIV + men, HIV clinical factors.
Results: In HIV+ men, current smoking was more prevalent than in HIV- men (31% vs. 22%), as were greater pack years (pk-yrs) of smoking (HIV+, 14±19; HIV- , 12±18). In HIV+ men only, current smoking was positively associated with presence of CAC, any plaque, calcified plaque (CP) and coronary artery stenosis >50% (OR 2.3 [1.3-3.9], 2.3 [1.1-4.7], 2.0 [1.1-3.9], 2.6 [1.1-6.0]), former smoking with CP and stenosis (OR 2.2 [1.2-3.8], 2.2 [1.1-4.7]) and heavy ETOH use (>14 drinks/week) with stenosis (OR 4.7 [1.5-14.8]). In HIV- men, cumulative pk-yrs of smoking was associated with CAC (OR 1.02 [1.002-1.03] per year) and stenosis (OR 1.02 [1.0001-1.04]), moderate (1-14 drinks/week) and heavy ETOH use were inversely associated with CAC extent (β -0.69, -1.14; p=0.02, p=0.02), heavy ETOH use inversely with CP extent (β -0.89, p=0.001) and binge drinking (> 5 drinks > once in the prior 30 days) positively with CP extent (β 0.85, p=0.02). Marijuana use was positively associated with CAC extent in HIV- men (β 0.005, p=0.02) and EDD use with CP extent in HIV+ men (β 0.06, p=0.02). No significant associations between plaque and cumulative stimulant or nitrite use were seen.
Conclusions: Smoking is common and strongly associated with subclinical coronary atherosclerosis among HIV+ men. Our findings underscore the value of effective smoking cessation strategies targeting HIV+ persons to decrease cardiovascular disease burden. Other forms of substance use, other than ETOH, were not consistently associated with atherosclerosis.