Cardiovascular

Elevated high sensitivity cardiac troponin T among men with HIV who use stimulants: A cross-sectional study of subclinical cardiovascular injury.

TL;DR

Co-occurring HIV and stimulant use were associated with higher hs-cTnT, with HIV+Stim+ participants having higher odds of detectable hs-cTnT (aOR = 7.48) and higher estimated mean concentration than the HIV-Stim- group.

Key Findings

Men with HIV who also used stimulants had significantly higher odds of having detectable high-sensitivity cardiac troponin T compared to HIV-negative non-stimulant users.

  • Adjusted odds ratio for detectable hs-cTnT in HIV+Stim+ vs. HIV-Stim- group: aOR = 7.48 (95% CI: 1.25, 44.62)
  • Model was adjusted for age and recent tobacco use
  • hs-cTnT was measured using a Roche high-sensitivity assay, with values below the limit of detection treated as undetectable
  • The study used a two-part model: logistic regression for detectability and log-normal model among participants with detectable hs-cTnT

Men with HIV who used stimulants had significantly higher estimated mean hs-cTnT concentrations than HIV-negative non-stimulant users.

  • β = 0.51, p = 0.031 for the HIV+Stim+ group compared to HIV-Stim- reference group
  • Estimated mean hs-cTnT concentration for HIV+Stim+ group was 12 (units not specified beyond assay description)
  • This association was found after adjusting for age and recent tobacco use
  • Sensitivity analyses added renal function and cardiometabolic factors

Exploratory analyses found a strong positive dose-response association between amphetamine metabolite levels and hs-cTnT concentrations.

  • Pearson correlation r(11) = 0.86, p < 0.0001
  • Analysis was conducted among the subset of participants with available amphetamine metabolite data (n = 11 degrees of freedom, suggesting n = 13)
  • This was characterized as an exploratory dose-response analysis
  • Stimulant exposure was defined as any non-prescribed stimulant use in the past 3 months and/or a reactive urine toxicology screen

The study enrolled 72 cisgender men with and without HIV in a cross-sectional secondary analysis from a South Florida cohort, creating four HIV-by-stimulant use groups.

  • Total sample size: n = 72 cisgender men
  • Four groups were created: HIV+Stim+, HIV+Stim-, HIV-Stim+, and HIV-Stim-
  • This was a cross-sectional secondary analysis
  • The cohort was based in South Florida, limiting generalizability
  • Stimulant exposure was operationalized using both self-report (past 3 months) and urine toxicology screening

People with HIV are noted to experience elevated cardiovascular disease risk compared to people without HIV, and stimulant use may further increase subclinical myocardial injury in this population.

  • Prior data on cardiovascular biomarkers including hs-cTnT in PWH who use stimulants was described as limited
  • hs-cTnT may reflect a range of acute, subacute, and chronic processes according to the authors
  • The authors emphasize findings are exploratory and hypothesis-generating due to small sample size and restricted generalizability
  • Confirmation in larger studies was recommended by the authors

What This Means

This research suggests that men living with HIV who also use stimulant drugs (such as amphetamines or cocaine) may have higher levels of a blood marker called high-sensitivity cardiac troponin T (hs-cTnT) compared to men without HIV who do not use stimulants. Troponin T is a protein released when heart muscle cells are damaged or stressed, and elevated levels — even at subclinical (below the threshold of obvious disease) amounts — can signal early or ongoing injury to the heart. In this study of 72 men in South Florida, those with both HIV and stimulant use were about 7.5 times more likely to have detectable troponin in their blood, and had higher concentrations of it, after accounting for age and tobacco use. Additionally, among those with urine toxicology data available, higher levels of amphetamine metabolites were strongly correlated with higher troponin levels, suggesting a possible dose-response relationship. This research matters because people living with HIV already face a higher risk of heart disease than those without HIV, and stimulant use is disproportionately common in some HIV-affected communities. Identifying early signs of heart injury — before symptoms appear — could be important for understanding and eventually addressing this elevated risk. However, the authors are careful to note that elevated troponin can reflect many different processes (acute, subacute, or chronic), and that this study was small, limited to cisgender men in one region, and designed as a preliminary, exploratory investigation. These findings should be considered hypothesis-generating and will need to be confirmed in larger, more diverse studies before broader conclusions can be drawn.

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Citation

Larson M, Pan Y, Reidy L, Cherenack E, Hirshfield S, Horvath K, et al.. (2026). Elevated high sensitivity cardiac troponin T among men with HIV who use stimulants: A cross-sectional study of subclinical cardiovascular injury.. PloS one. https://doi.org/10.1371/journal.pone.0350086