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  Conference on Retroviruses
and Opportunistic Infections
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March 6-10, 2021
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HIV Linked to 4.5-Fold Higher Risk of Aortic Aneurysm
  CROI 2021, Conference on Retroviruses and Opportunistic Infections, March 6-10, 2021
Mark Mascolini
People with HIV run a 4.5-fold higher risk of aortic aneurysm than people the same age and sex in the general population, according to results of a 1782-person case-control comparison in Denmark [1]. The study independently linked older age, obesity, and hepatitis B coinfection to higher odds of aortic aneurysm in people with HIV.
Aortic aneurysm is a balloon-like bulge in the aorta, the big artery carrying blood from the heart to the torso [2]. In 2018 these aneurysms caused 9923 deaths in the United States. Smoking is tied 75% of all abdominal aortic aneurysms [2].
Although the literature abounds in case reports of aortic aneurysm in people with HIV, little is known about their prevalence and risk in HIV populations. Researchers at Copenhagen's Rigshospitalet and collaborators at other centers addressed these questions by mounting a case-control study comparing aortic aneurysm rates in people with versus without HIV.
The analysis focused on HIV-positive people 40 or older in the Copenhagen Comorbidity in HIV Infection (COCOMO) study. Researchers matched each HIV-positive person by sex and age to 2 HIV-negative people in the Copenhagen General Population Study. All participants had contrast-enhanced CT scans to look for aneurysms, which the researchers defined according to guidelines of the European Society of Cardiology (ascending aorta diameter at or above 45 mm and/or descending aorta diameter at or above 35 mm and/or suprarenal and/or infrarenal abdominal aorta diameter at or above 30 mm).
The study included 594 people with HIV and 1188 HIV-negative controls. Most participants were men (88% with HIV and 90% without HIV), and median age stood at 52 years in both groups.
Forty-two people with HIV had 46 aortic aneurysms, meaning 7.1% of individuals had one or more aneurysms. In the HIV-negative group, 29 people had 31 aneurysms, meaning 2.4% of individuals had one or more aneurysms. Statistical analysis adjusted for age, sex, hypertension, smoking status, body mass index, high lipids, and country of origin determined that people with HIV had 4.51 higher odds of aortic aneurysm (95% confidence interval [CI] 2.56 to 8.08).
Three factors independently predicted aortic aneurysm in people with HIV. Every additional 10 years of age more than tripled aneurysm odds (adjusted odds ratio [aOR] 3.25, 95% CI 2.13 to 4.95). Obesity boosted odds more than 5-fold (aOR 5.12, 95% CI 1.44 to 18.24). And hepatitis B coinfection raised odds more than 5-fold (aOR 5.57, 95% CI 1.47 to 21.12).
In the general population, smoking, high blood pressure, high blood cholesterol, and atherosclerosis are the main risk factors for aortic aneurysm [2]. And aneurysms develop in about half of people with cardiovascular syphilis [3]. But none of these factors predicted aneurysm in the Copenhagen study; nor did antiretroviral therapy.
The Copenhagen researchers believe their findings should encourage closer attention to aortic aneurysm in people with HIV and more study to determine whether screening for aneurysms would be helpful in HIV populations. Whether their findings apply to women with HIV remains uncertain, because women made up only 12% of the HIV study group.
1. Hogh J, Pham MH, Knudsen AD, et al. HIV infection is independently associated with aortic aneurysms. CROI 2021, Conference on Retroviruses and Opportunistic Infections, March 6-10, 2021. Abstract 499.
2. Centers for Disease Control and Prevention. Aortic aneurysm. https://www.cdc.gov/heartdisease/aortic_aneurysm.htm 3. Mabey D, Richens J. Syphilis and the endemic treponematoses. Hunter's Tropical Medicine and Emerging Infectious Disease (Ninth Edition). 2013, pages 494-500.