Association of HIV Infection and Incident Abdominal Aortic Aneurysm Among 143 001 Veterans

Overview

Journal Circulation

Specialty Cardiology & Vascular Diseases

Date 2023 May 25

PMID 37226738

Authors

Alexandra M Filipkowski

Suman Kundu

Svetlana K Eden

Charles W Alcorn

Amy C Justice

Kaku A So-Armah

Hilary A Tindle

Quinn S Wells

Joshua A Beckman

Matthew S Freiberg

Aaron W Aday

Affiliations

Soon will be listed here.

Abstract

Background: People with HIV (PWH) have an increased risk of cardiovascular disease. Previous cross-sectional data suggest there is a higher prevalence of abdominal aortic aneurysm (AAA) in PWH than in those without HIV. Whether PWH have an increased risk of incident AAA compared with those without HIV is unknown.

Methods: We analyzed data among participants without prevalent AAA from the Veterans Aging Cohort Study, a prospective, observational, longitudinal cohort of veterans with HIV matched 1:2 with veterans without HIV infection. We calculated AAA rates by HIV status and assessed the association between HIV infection and incident AAA using Cox proportional hazards models. We defined AAA using the International Classification of Diseases, 9th or 10th revision, or Current Procedural Terminology codes and adjusted all models for demographic characteristics, cardiovascular disease risk factors, and substance use. Secondary analyses examined the association between time-varying CD4+ T-cell count or HIV viral load and incident AAA.

Results: Among 143 001 participants (43 766 with HIV), over a median follow-up of 8.7 years, there were 2431 incident AAA events (26.4% among PWH). Rates of incident AAA per 1000 person-years were similar among PWH (2.0 [95% CI, 1.9-2.2]) and people without HIV (2.2 [95% CI, 2.1-2.3]). There was no evidence that HIV infection increased the risk of incident AAA compared with no HIV infection (adjusted hazard ratio, 1.02 [95% CI, 0.92-1.13]). In adjusted analyses with time-varying CD4+ T-cell counts or HIV viral load, PWH with CD4+ T-cell counts <200 cells/mm (adjusted hazard ratio, 1.29 [95% CI, 1.02-1.65]) or HIV viral load ≥500 copies/mL (adjusted hazard ratio, 1.29 [95% CI, 1.09-1.52]) had an increased risk of AAA compared with those without HIV.

Conclusions: HIV infection is associated with an increased risk of AAA among those with low CD4+ T-cell counts or elevated HIV viral load over time.

Citing Articles

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Troseid M, Nielsen S, Vujkovic-Cvijin I Microbiome. 2024; 12(1):106.

PMID: 38877521 PMC: 11177534. DOI: 10.1186/s40168-024-01815-y.

References

Mathers C, Stevens G, Boerma T, White R, Tobias M . Causes of international increases in older age life expectancy. Lancet. 2014; 385(9967):540-8. DOI: 10.1016/S0140-6736(14)60569-9. View

Goulet J, Fultz S, McGinnis K, Justice A . Relative prevalence of comorbidities and treatment contraindications in HIV-mono-infected and HIV/HCV-co-infected veterans. AIDS. 2005; 19 Suppl 3:S99-105. DOI: 10.1097/01.aids.0000192077.11067.e5. View

Fultz S, Skanderson M, Mole L, Gandhi N, Bryant K, Crystal S . Development and verification of a "virtual" cohort using the National VA Health Information System. Med Care. 2006; 44(8 Suppl 2):S25-30. DOI: 10.1097/01.mlr.0000223670.00890.74. View

Chehab O, Kanj A, Zeitoun R, Mir T, Shafi I, Pahuja M . Association of HIV infection with clinical features and outcomes of patients with aortic aneurysms. Vasc Med. 2022; 27(6):557-564. DOI: 10.1177/1358863X221122577. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

Mdodo R, Frazier E, Dube S, Mattson C, Sutton M, Brooks J . Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med. 2015; 162(5):335-44. DOI: 10.7326/M14-0954. View

Tawakol A, Ishai A, Li D, Takx R, Hur S, Kaiser Y . Association of Arterial and Lymph Node Inflammation With Distinct Inflammatory Pathways in Human Immunodeficiency Virus Infection. JAMA Cardiol. 2016; 2(2):163-171. PMC: 5310978. DOI: 10.1001/jamacardio.2016.4728. View

Wandeler G, Johnson L, Egger M . Trends in life expectancy of HIV-positive adults on antiretroviral therapy across the globe: comparisons with general population. Curr Opin HIV AIDS. 2016; 11(5):492-500. PMC: 5055447. DOI: 10.1097/COH.0000000000000298. View

Armah K, McGinnis K, Baker J, Gibert C, Butt A, Bryant K . HIV status, burden of comorbid disease, and biomarkers of inflammation, altered coagulation, and monocyte activation. Clin Infect Dis. 2012; 55(1):126-36. PMC: 3493182. DOI: 10.1093/cid/cis406. View

10.

Freiberg M, Chang C, Skanderson M, Patterson O, DuVall S, Brandt C . Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy Era: Results From the Veterans Aging Cohort Study. JAMA Cardiol. 2017; 2(5):536-546. PMC: 5541383. DOI: 10.1001/jamacardio.2017.0264. View

11.

Lederle F, Johnson G, Wilson S, Chute E, Hye R, Makaroun M . The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med. 2000; 160(10):1425-30. DOI: 10.1001/archinte.160.10.1425. View

12.

Ashare R, Thompson M, Serrano K, Leone F, Metzger D, Frank I . Placebo-controlled randomized clinical trial testing the efficacy and safety of varenicline for smokers with HIV. Drug Alcohol Depend. 2019; 200:26-33. PMC: 6588414. DOI: 10.1016/j.drugalcdep.2019.03.011. View

13.

Lucas M, Binotto I, Behar P, Erling Jr N, Lichtenfels E, Aerts N . Thoracoabdominal Aortic Aneurysm in a HIV-positive Patient. Braz J Cardiovasc Surg. 2017; 32(1):53-56. PMC: 5382901. DOI: 10.21470/1678-9741-2016-0045. View

14.

Hogh J, Pham M, Knudsen A, Thudium R, Gelpi M, Sigvardsen P . HIV infection is associated with thoracic and abdominal aortic aneurysms: a prospective matched cohort study. Eur Heart J. 2021; 42(30):2924-2931. DOI: 10.1093/eurheartj/ehab348. View

15.

Miao T, Wang T, Feng T, Yuan D, Guo Q, Xiong F . Activated invariant natural killer T cells infiltrate aortic tissue as key participants in abdominal aortic aneurysm pathology. Immunology. 2021; 164(4):792-802. PMC: 8561115. DOI: 10.1111/imm.13401. View

16.

. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1151-1210. PMC: 5605883. DOI: 10.1016/S0140-6736(17)32152-9. View

17.

Austin P, Lee D, Fine J . Introduction to the Analysis of Survival Data in the Presence of Competing Risks. Circulation. 2016; 133(6):601-9. PMC: 4741409. DOI: 10.1161/CIRCULATIONAHA.115.017719. View

18.

. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017; 4(8):e349-e356. PMC: 5555438. DOI: 10.1016/S2352-3018(17)30066-8. View

19.

Ledgerwood D, Yskes R . Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis. Nicotine Tob Res. 2016; 18(12):2177-2184. PMC: 5103932. DOI: 10.1093/ntr/ntw126. View

20.

Hsue P, Waters D . HIV infection and coronary heart disease: mechanisms and management. Nat Rev Cardiol. 2019; 16(12):745-759. PMC: 8015945. DOI: 10.1038/s41569-019-0219-9. View