High-risk Coronary Plaque Regression in Cash-based Contingency Management Intervention Among Cocaine Users With HIV-associated Subclinical Coronary Atherosclerosis. Issue 2 (24th March 2023)

• Record Type: Journal Article
• Authors: Lai, Hong; Bluemke, David A.; Fishman, Elliot K.; Gerstenblith, Gary; Celentano, David D.; Treisman, Glenn; Foster, Parker; Mandler, Raul; Khalsa, Jag; Chen, Shaoguang; Bhatia, Sandeepan; Kolossváry, Márton; Lai, Shenghan
• Is Part Of: Journal of addiction medicine. Volume 17:Issue 2(2023)
• Page Start: 147
• Page End: 154
• Publication Date: 2023-03-24
• Subjects: contingency management intervention -- cocaine user -- HIV infection -- noncalcified coronary plaque volume -- low-attenuation noncalcified coronary plaque volume; Substance abuse -- Periodicals; Substance abuse -- Treatment -- Periodicals; Substance-Related Disorders -- Periodicals; 616.86005
• DOI: 10.1097/ADM.0000000000001057
• Languages: English
• ISSNs: 1932-0620

Abstract

Abstract : Background: Cocaine use exacerbates human immunodeficiency virus (HIV)–associated subclinical coronary atherosclerosis. We investigated whether cocaine abstinence or reduced use achieved with contingency management (CM) intervention would retard high-risk coronary plaque progression among cocaine users with HIV and subclinical coronary atherosclerosis. Methods: Between March 2014 and August 2017, 76 cocaine users with HIV and coronary plaques were enrolled in a study designed to decrease cocaine use and determine whether doing so impacted progression of subclinical coronary atherosclerosis as measured by coronary artery computed tomography examinations. Of the 76, 7 did not complete the study, resulting in 69 participants. A 12-month cash-based CM intervention was implemented to promote cocaine abstinence or reduced cocaine use. Generalized estimating equation approach was used to perform longitudinal data analyses. Findings: During the 12-month CM, all 69 participants reduced cocaine use, and of these, 25 (36%; 95% confidence interval, 25%–49%) achieved cocaine abstinence. After adjusting for potential confounding factors, generalized estimating equation analyses showed that (1) endothelin-1 (ET-1) levels, a proinflammatory biomarker for endothelial dysfunction, at the 6-month and 12-month visits were significantly lower compared with baseline ET-1 ( P = 0.001 and P < 0.001, respectively), and (2) low-attenuation noncalcified coronary plaque volume, a predictor for myocardial infarction, at 12-month visit was significantly lower compared with baseline low-attenuation noncalcified coronary plaque volume ( P < 0.05). Conclusions: The findings of this study have not only demonstrated that CM is effective in achieving a sustained reduction in cocaine use, but also provided compelling evidence that reduction in cocaine use leads to quantifiable cardiovascular health benefits, including concurrent decrease in high-risk plaque burden and ET-1, among cocaine users with HIV-associated coronary atherosclerosis.