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Smoking, atherosclerosis common among MSM with HIV

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SEATTLE — Smoking rates appeared high among men who have sex with men with HIV and were associated with subclinical coronary atherosclerosis, according to data presented at CROI 2015.

Sean Kelly, MD, of the infectious disease department at Northwestern University Feinberg School of Medicine, and colleagues examined the coronary artery calcium (CAC) of 1,005 MSM enrolled in the Multicenter AIDS Cohort Study, including 612 infected with HIV. Participants semiannually self-reported recreational substance use up to 10 years prior, including tobacco, alcohol, stimulants, marijuana, inhaled nitrites and erectile dysfunction medication. CAC was measured in all patients through noncontrast computed tomography, with coronary CT angiograms (n = 764) also performed. Prevalence was determined through regression models stratified by HIV serostatus adjusted for age, race, education, CVD risk factors and HIV clinical factors.

Sean Kelly

Thirty-one percent of men with HIV were current smokers, compared with 22% of men without HIV. For patients with HIV, smoking was associated with CAC (OR = 2.3; 95% CI, 1.3-3.9), any plaque (OR = 2.3, 95% CI, 1.1-4.7), calcified plaque (OR = 2; 95% CI, 1.1-3.9) and coronary artery stenosis greater than 50% (OR = 2.6; 95% CI, 1.1-6), and former smoking with calcified plaque (OR = 2.2; 95% CI, 1.2-3.8) and stenosis (OR = 2.2; 95% CI, 1.1-4.7). Reporting more than 14 alcoholic drinks per week also was associated with stenosis (OR = 4.7; 95% CI, 1.5-14.8).

Higher cumulative pack-years reported by men without HIV were associated with CAC (yearly OR = 1.02; 95% CI, 1.002-1.03) and stenosis (OR = 4.7; 95% CI, 1.0001-1.04). While binge drinking was associated with a greater extent of calcified plaque (P = .02), an inverse association was seen between calcified plaque in heavy drinkers (P = .001) and CAC in both heavy (P = .02) and moderate (P = .02) drinkers.

Use of marijuana was positively associated with CAC extent in men without HIV (P = .02), and erectile dysfunction drug use with calcified plaque extent in men with HIV (P = .02). No associations between plaque and cumulative stimulants or nitrites were seen in either group.

“No surprise — smoking is terrible, but it’s especially terrible in HIV-infected men,” Kelly told Infectious Disease News. “We still don’t know what the trajectory of these specific types of plaque are, so we’re going to have to keep following up to see what the data mean clinically for this subset of patients.” – by Dave Muoio

Reference:

Kelly S, et al. Abstract 743. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.

Disclosure: The researchers report no relevant financial disclosures.