Aortic aneurysm risk four times higher in people living with HIV vs. without

The risk for aortic aneurysms among people living with HIV was increased fourfold compared with people without HIV, and HIV status was independently associated with aortic aneurysms, researchers reported.

Currently, little is known concerning the prevalence of aortic aneurysms in people living with HIV (PLWH), Julie Høgh, of the University of Copenhagen, and colleagues wrote in a study published in the European Heart Journal. Høgh and colleagues aimed to assess whether HIV status is independently associated with having aortic aneurysms, while also determining risk factors associated with aortic aneurysms in PLWH.

The study included 594 PLWH aged 40 years or older from the Copenhagen Comorbidity in HIV Infection study who were matched for age and sex with 1,188 uninfected controls from the Copenhagen General Population Study.

Researchers defined aortic aneurysms according to the European Society of Cardiology guidelines — an aortic dilation of 50% or an infrarenal aortic diameter of 30 mm— and evaluated aortic dimensions with contrast-enhanced CT.

Median age was 52 years in both groups. Ninety percent of patients in the uninfected control cohort were men compared with 88% in the PLWH cohort.

Results indicated a significantly higher rate of aneurysms in the PLWH arm (7.1% vs. 2.4%; P < .001), with a higher prevalence of ascending aortic aneurysms and infrarenal aortic aneurysms in this group. All aortic aneurysms in both groups were reported in men, with male sex being a well-described risk factor for aortic aneurysms, the researchers wrote.

“In this study, we only observed aneurysms among men, and we were not able to determine the effect of sex,” they wrote. “We might have found more aneurysms among women if we had used cut-offs that were age-, sex- and body size-specific, but whether this would be clinically significant is unknown.”

In an adjusted model, HIV was independently linked to aortic aneurysms (adjusted OR = 4.51; 95% CI, 2.56-8.08; P < .001). Furthermore, obesity and hepatitis B co-infection were associated with aortic aneurysms among PLWH.

“Our findings suggest that HIV infection is an independent risk factor for aortic aneurysms,” the researchers wrote, noting the data also suggest that screening for aortic aneurysms in PLWH may be beneficial. “This should be investigated in larger prospective trials with clinical endpoints.”

By Brian Ellis

Source: Høgh J, et al. Eur Heart J. 2021;doi:10.1093/eurheartj/ehab348.