University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA.
San Francisco VA Health Care System, Division of Cardiology, San Francisco, CA, USA; University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
Drug Alcohol Depend. 2022 Sep 1;238:109564. doi: 10.1016/j.drugalcdep.2022.109564. Epub 2022 Jul 8.
Cardiovascular disease (CVD) and heart failure (HF) are disproportionately high in people living with HIV and differ by sex. Few CVD-related studies focus on drug use, yet it is common in low-income women living with HIV (WLWH) and increases cardiac dysfunction.
We recruited unsheltered and unstably housed WLWH from San Francisco community venues to participate in a six-month cohort study investigating linkages between drug use, inflammation, and cardiac dysfunction.
Adjusting for CVD risk factors, co-infections, medications, and menopause, we examined the effects of toxicology-confirmed drug use and inflammation (C-reactive protein, sCD14, sCD163 and sTNFR2) on levels of NT-proBNP, a biomarker of cardiac stretch and HF.
Among 74 WLWH, the median age was 53 years and 45 % were Black. At baseline, 72 % of participants had hypertension. Substances used included tobacco (65 %), cannabis (53 %), cocaine (49 %), methamphetamine (31 %), alcohol (28 %), and opioids (20 %). Factors significantly associated with NT-proBNP included cannabis use (Adjusted Relative Effect [ARE]: -39.6 %) and sTNFR2 (ARE: 65.5 %). Adjusting for heart failure and restricting analyses to virally suppressed persons did not diminish effects appreciably. Cannabis use was not significantly associated with sTNFR2 and did not change the association between sTNFR2 and NT-proBNP.
Among polysubstance-using WLWH, NT-proBNP levels signaling cardiac stretch were positively associated with sTNFR2, but 40 % lower in people who used cannabis. Whether results suggest that cardiovascular pathways associated with cannabis use mitigate cardiac stress and dysfunction independent of inflammation in WLWH who use multiple substances merits further investigation.
心血管疾病（CVD）和心力衰竭（HF）在感染艾滋病毒的人群中发病率极高，且存在性别差异。少数与 CVD 相关的研究集中在药物使用上，但这在感染艾滋病毒的低收入女性（WLWH）中很常见，且会增加心脏功能障碍。
我们从旧金山社区场所招募了无家可归和住房不稳定的 WLWH，让她们参与一项为期六个月的队列研究，以调查药物使用、炎症和心脏功能障碍之间的联系。
在调整 CVD 风险因素、合并感染、药物和绝经后，我们研究了经毒物学确认的药物使用和炎症（C 反应蛋白、sCD14、sCD163 和 sTNFR2）对 NT-proBNP 水平的影响，NT-proBNP 是心脏拉伸和 HF 的生物标志物。
在 74 名 WLWH 中，中位年龄为 53 岁，45%为黑人。基线时，72%的参与者患有高血压。使用的物质包括烟草（65%）、大麻（53%）、可卡因（49%）、冰毒（31%）、酒精（28%）和阿片类药物（20%）。与 NT-proBNP 显著相关的因素包括大麻使用（调整后的相对效应 [ARE]：-39.6%）和 sTNFR2（ARE：65.5%）。调整心力衰竭并将分析限制在病毒抑制的人群中，并没有明显降低影响。大麻使用与 sTNFR2 无显著相关性，且不改变 sTNFR2 与 NT-proBNP 之间的关联。
在多种物质使用的 WLWH 中，提示心脏拉伸的 NT-proBNP 水平与 sTNFR2 呈正相关，但使用大麻的人群中低 40%。大麻使用与心血管途径相关，是否能独立于 WLWH 中使用多种物质的炎症减轻与心脏压力和功能障碍相关，值得进一步研究。
