Association of HIV Serostatus and Inflammation With Ascending Aortic Size

Abstract

Background The prevalence and extent of subclinical large vessel vasculopathy is not well defined among people living with HIV. We aimed to evaluate associations between aortic root and ascending aortic sizes measured by 2‐dimensional transthoracic echocardiography and HIV serostatus, and to identify risk factors for larger aortic sizes among men with HIV, including levels of circulating inflammatory markers. Methods and Results Using clinical and echocardiographic data from the MACS (Multicenter AIDS Cohort Study), adjusted multivariable linear and logistic regression was performed. Four segments of the proximal aorta were measured: aortic annulus, aortic root at the sinuses of Valsalva, sinotubular junction, and ascending aorta. HIV infection was associated with significantly larger aortic root (0.03 cm [95% CI, 0.002–0.06 cm]) and ascending aorta (0.04 cm [95% CI, 0.01–0.06 cm]) diameters. Higher standardized nadir CD4 (cluster of differentiation 4) T‐cell count was significantly associated with smaller aortic root (−0.03 cm [95% CI, −0.05 to −0.01 cm]), sinotubular junction (−0.03 cm [95% CI, −0.05 to −0.01 cm]), and ascending aorta (−0.03 cm [95% CI, −0.05 to −0.004 cm]) diameters. Higher levels of standardized TNF‐α (tumor necrosis factor‐α) were associated with larger diameters of the aortic annulus (0.02 cm [95% CI, 0.003–0.04 cm]) and sinotubular junction (0.02 cm [95% CI, 0.002–0.04 cm]). There were no other cardiovascular or HIV disease severity–related risk factors associated with the aortic dimensions. Conclusions HIV infection is an independent risk factor for greater ascending aortic sizes. Lower nadir CD4 T‐cell count and higher TNF‐α levels are associated with larger aortic sizes in men with HIV. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00046280.

Association of HIV infection with clinical features and outcomes of patients with aortic aneurysms

“…Moreover, patients with lower CD4 counts had significantly larger aortic dimensions; however, the prevalence of AA (> 5 cm) was relatively low at 0.15%. 7 In addition, similarly to Høgh et al 8 and Subramanian et al, 23 viral load was not associated with increased aortic diameter.…”

“…5,6 We recently reported larger aortic root and ascending aorta diameters among HIV seropositive men compared to HIV seronegative referents. 7 Recent analysis of a prospective cohort from Copenhagen showed a fourfold increased risk of aortic aneurysms (AA) among people living with HIV compared with HIV seronegative cohort participants (OR: 4.51; 95% CI: 2.56–8.08, p < 0.001). 8 Given the higher prevalence of AA with advancing age and the increased longevity of people living with HIV, it would be expected that the incidence of AA will subsequently increase in this population.…”

Spectrum of ascending aortic aneurysms at a peri-urban tertiary hospital: an echocardiography-based study

“…Recent work by Høgh et al has shown a direct association between HIV and TAA aneurysms. It was found that there was a four-fold higher odds of aortic aneurysms compared to uninfected controls likely due to the proinflammatory state associated with HIV ( 8 , 9 ). Given that Southern Africa has amongst the highest rates of people living with HIV globally, HIV is thus an important cause of aortic aneurysms in this population ( 10 , 11 ).…”