Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, School of Medicine, San Francisco, CA.
Department of Epidemiology and Biostatistics, University of California, School of Medicine, San Francisco, CA.
J Acquir Immune Defic Syndr. 2024 Apr 1;95(4):342-346. doi: 10.1097/QAI.0000000000003366.
People living with HIV have increased risk of cardiovascular disease, but few studies focus on women with HIV (WWH) and few account for the use of multiple substances.
We recruited WWH from San Francisco shelters, free meal programs, street encampments, and a safety net HIV clinic.
Between 2016 and 2019, participants completed 6 monthly interviews, specimen collection, and a transthoracic echocardiogram. We assessed associations between 3 echocardiographic indices of cardiac hypertrophy (concentric hypertrophy, concentric remodeling, and eccentric hypertrophy) and study factors, including cardiovascular risk factors, substance use, and HIV-specific factors (CD4 + count, viral load, HIV medication).
Among 62 participants, the average age was 53 years and 70% were ethnic minority women. Just over 70% had elevated blood pressure. Toxicology-confirmed substance use included tobacco (63%), cannabis (52%), cocaine (51%), methamphetamine (29%), and alcohol (26%). Concentric hypertrophy was detected in 26% of participants. It was positively associated with cocaine use [adjusted relative risk (aRR) = 32.5, P < 0.01] and negatively associated with cannabis use (aRR = 0.07, P < 0.01). Concentric remodeling was detected in 40% of participants. It was positively associated with cocaine use (aRR = 11.2, P < 0.01) and negatively associated with cannabis use (aRR = 0.17, P = 0.02). Eccentric hypertrophy was not significantly associated with factors studied here.
Routine evaluation of stimulant use as a contributing factor to cardiovascular risk may improve risk assessment in WWH. Whether cannabis use mitigates the impact of cocaine use on structural heart disease among WWH merits further investigation.
感染艾滋病毒的人患心血管疾病的风险增加，但很少有研究关注感染艾滋病毒的女性（WWH），也很少有研究考虑多种物质的使用。
我们从旧金山的收容所、免费餐食计划、街头营地和一个艾滋病毒安全网诊所招募了 WWH。
在 2016 年至 2019 年期间，参与者完成了 6 个月的访谈、标本采集和经胸超声心动图检查。我们评估了 3 种超声心动图心肌肥厚指标（向心性肥厚、向心性重构和离心性肥厚）与研究因素之间的关联，包括心血管危险因素、物质使用以及艾滋病毒特异性因素（CD4+计数、病毒载量、艾滋病毒药物）。
在 62 名参与者中，平均年龄为 53 岁，70%是少数族裔女性。超过 70%的人血压升高。经毒物学确认的物质使用包括烟草（63%）、大麻（52%）、可卡因（51%）、冰毒（29%）和酒精（26%）。26%的参与者检测出向心性肥厚。可卡因使用与向心性肥厚呈正相关（调整后的相对风险[aRR] = 32.5，P < 0.01），而大麻使用与向心性肥厚呈负相关（aRR = 0.07，P < 0.01）。40%的参与者检测出向心性重构。可卡因使用与向心性重构呈正相关（aRR = 11.2，P < 0.01），而大麻使用与向心性重构呈负相关（aRR = 0.17，P = 0.02）。离心性肥厚与我们研究的因素无显著相关性。
常规评估兴奋剂使用情况作为心血管风险的一个促成因素，可能会改善 WWH 的风险评估。大麻使用是否能减轻 WWH 中可卡因使用对结构性心脏病的影响，值得进一步研究。
