Cocaine, HIV, and their cardiovascular effects: Is there a role for ACE-inhibitor therapy?

Cocaine abuse and HIV disease each have potentially adverse effects upon th e heart and cardiovascular system which may be exacerbated when these risk factors are combined. The development of a safe and effective agent to trea t both cocaine addiction and its cardiovascular sequelae, that is well-tole rated by HIV patients, would thus be of considerable clinical utility. In t his article we discuss the rationale for the investigation of angiotensin c onverting enzyme (ACE) inhibitors, commonly used to treat hypertension, for treatment in cocaine-abusing populations, based on their potential to redu ce cocaine use by modulating levels of dopamine and corticotropin releasing factor in the brain, and on their ability to reverse cardiovascular and pl atelet abnormalities. We present preliminary findings from echocardiographi c and platelet activation studies in 16 HIV-positive, cocaine abusing patie nts, as well as tolerability and efficacy studies of the ACE-inhibitor, fos inopril, for the treatment of cocaine abuse in both HIV-positive (n = 6) an d HIV-negative (n = 5) methadone-maintained cocaine abusers. Findings sugge st that HIV-positive cocaine-abusing patients possess abnormalities of dias tolic heart function and platelet activation that are potentially reversibl e with ACE-inhibitor therapy. Findings also suggest that fosinopril is well -tolerated regardless of HIV serostatus, does not appear to cause hypotensi on, and may possess effectiveness for reducing cocaine use. We conclude tha t ACE-inhibitor therapy may offer a new pharmacologic approach to the treat ment of cocaine abuse and its complications, and that, controlled research of this class of agents may be promising. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.