HIV infection is associated with thoracic and abdominal aortic aneurysms: a prospective matched cohort study

Høgh, Julie; Pham, Michael Huy Cuong; Knudsen, Andreas Dehlbæk; Thudium, Rebekka Faber; Gelpi, Marco; Sigvardsen, Per E; Fuchs, Andreas; Kühl, Jørgen Tobias; Afzal, Shoaib; Nordestgaard, Børge G.; Benfield, Thomas; Køber, Lars; Gerstoft, Jan; Kofoed, Klaus F.; Nielsen, Susanne Dam

doi:10.1093/eurheartj/ehab348

Cited by 22 publications

(42 citation statements)

References 43 publications

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“…Using the Danish definition of ascending aorta dilation by computed tomography of ≥4.5 cm to define aneurysm, the rate of ascending aortic aneurysm in that study was low at 2.4%. 11 Høgh et al found no significant associations between non‐HIV and HIV‐related disease‐severity risk factors and aortic aneurysms including nadir CD4 count and inflammatory biomarker levels. 11 In contrast to the Danish study, our cohort was racially diverse and older, with lower rates of HIV viral suppression.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Høgh et al found no significant associations between non‐HIV and HIV‐related disease‐severity risk factors and aortic aneurysms including nadir CD4 count and inflammatory biomarker levels. 11 In contrast to the Danish study, our cohort was racially diverse and older, with lower rates of HIV viral suppression. Cardiac risk factor prevalence between the MWH and MWOH in our cohort was generally similar except for a higher rate of dyslipidemia and resultant statin therapy.…”

Section: Discussionmentioning

confidence: 99%

“… 10 A recent Danish study by Høgh et al of predominantly men living with and without HIV found differences in prevalent aortic aneurysms detected by computed tomography imaging by HIV serostatus. 11 Aneurysms of the ascending aorta and infrarenal aorta were more common among MWH, with no aneurysms detected in women. Using the Danish definition of ascending aorta dilation by computed tomography of ≥4.5 cm to define aneurysm, the rate of ascending aortic aneurysm in that study was low at 2.4%.…”

Section: Discussionmentioning

confidence: 99%

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Association of HIV Serostatus and Inflammation With Ascending Aortic Size

Minhas

Post

Liu

et al. 2022

JAHA

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association of HIV Serostatus and Inflammation With Ascending Aortic Size

Minhas

Post

Liu

et al. 2022

JAHA

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“…Finally, only one of the PWH with aortic aneurysm in this study were evaluated to need surgical procedure. The fact that in both these studies only a few cases of PWH, who were diagnosed with an aortic aneurysm, had surgery performed [13,34] could indicate that most of the aortic aneurysms were not of clinical significance. Complications for smaller aortic aneurysms occur infrequently [39] and severe cases of aortic aneurysms with potential complications among PWH seems to be rare as well.…”

Section: Discussionmentioning

confidence: 99%

“…As both clinical consequential aneurysms and ruptures are rare, studies that investigate the association between HIV infection and the risk of aneurysms or associated subarachnoid haemorrhages should be large-scale observational studies. However, previous evidence from case-series or crosssectional studies is hampered by small study sizes and lack of well matched comparison cohorts or investigated molecular or pathological mechanisms rather than risk [4][5][6]8,[10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Risk of subarachnoid haemorrhages and aneurysms in Danish People Living With HIV, a nationwide cohort study

Tetens

Gerstoft

Kronborg

et al. 2022

Aids

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Objective: It remains unclear whether people with HIV (PWH) have increased risk of aneurysms. We aimed to investigate if the risk of subarachnoid haemorrhage, cerebral aneurysm, aortic aneurysm and other arterial aneurysms and dissections is increased in PWH compared with the general population. Design: We performed a nationwide population-based matched cohort study. Methods: We compared PWH with age-matched and sex-matched comparison cohort members to calculate incidence rate ratios (IRR) of subarachnoid haemorrhage, cerebral aneurysm, aortic aneurysm and other arterial aneurysms and dissections as well as surgery for these conditions. Results: We included all PWH, who were Danish residents and treated at a HIV healthcare centre between January 1995 and February 2018 (n = 6935) and an age-matched and sex-matched comparison cohort (n = 55 480). PWH had increased risk of subarachnoid haemorrhage (IRR 1.7, 95% CI, 1.1–2.6), but no increased risk of surgery for this condition. PWH had no increased risk of cerebral aneurysm or aortic aneurysm or surgery for these conditions. The risk of other arterial aneurysms and dissections was increased in PWH (IRR 2.0, 95% CI, 1.4–2.9), but this only applied for PWH who reported intravenous substance use as a route of HIV transmission (IRR 18.4, 95% CI, 9.3–36.6), and not for PWH without reported injection drug use (IRR 1.2, 95% CI, 0.73–1.7). Conclusion: PWH were not at an increased risk of cerebral, aortic or other arterial aneurysms and dissections. Although PWH were at an increased risk of subarachnoid haemorrhage, subarachnoid haemorrhages were rare among PWH.

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Subclinical vascular damage in Schistosoma spp. endemic regions

Silvestri

Mshana

Mushi

et al. 2023

Vasa

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Summary: Background: Cardiovascular abnormalities have been described in patients with schistosomiasis. Their true prevalence and clinical features in endemic settings are unknown. Patients and methods: The study aimed to assess the prevalence of subclinical cardiovascular damage in a population endemic to schistosomiasis. A cross-sectional study was conducted using colour-ultrasound assessment of abdominal and carotid arteries among adults aged >18 years living in Kome Island, Tanzania. Carotid intimal medial thickness, carotid plaque, mean abdominal aortic diameter, and presence of aneurysms were assessed. Anamnestic data on previous Schistosoma infection was collected; the actual prevalence of Schistosoma mansoni and Schistosoma haematobium was also assessed through stool and urine investigations. Results: A total of 264 participants (166 female, 98 male) were enrolled (mean age of 50±15.5 years). The history of previous schistosomiasis was 27.3%, and actual positivity for Schistosoma mansoni was 5.9%. The Latero-lateral Abdominal Aortic Diameter was significantly increased among participants with a previous history of schistosomiasis (16.7±2.8 mm vs. 17.6±3 mm; p=0.02), with an aOR of 1.15 [CI 1.04–1.28]; p=0.007]. Conclusions: The significant difference in the Latero-lateral Abdominal Aortic Diameter in participants with previous Schistosomiasis history schistosomiasis, suggests the need for further investigations on aortic damage in endemic populations, independently from the positive laboratory investigations.

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HIV infection is associated with thoracic and abdominal aortic aneurysms: a prospective matched cohort study

Cited by 22 publications

References 43 publications

Association of HIV Serostatus and Inflammation With Ascending Aortic Size

Association of HIV Serostatus and Inflammation With Ascending Aortic Size

Risk of subarachnoid haemorrhages and aneurysms in Danish People Living With HIV, a nationwide cohort study

Subclinical vascular damage in Schistosoma spp. endemic regions

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