Characteristics of Aneurysmal Disease in Human Immunodeficiency Virus-Positive Patients

Abstract

The advent of antiretroviral therapy has substantially improved the survival of human immunodeficiency virus (HIV)-positive patients. However, this increased longevity has led to the emergence of HIV-related diseases, including HIV-associated vasculopathy and aneurysm formation. However, the majority of the literature regarding HIV-associated vasculopathy has been limited to case reports. Thus, our aim was to investigate the characteristics of aneurysmal disease in HIV-positive patients in a multicenter study. All patients with a diagnosis of aneurysmal disease and HIV were retrospectively identified from 2011 through 2018 across two institutions. Comorbidities, HIV-related characteristics, and associated imaging were reviewed. There was a total of 104 HIV-positive patients with aneurysmal disease. Ascending (43.3%), abdominal (22.1%), and cerebral (11.5%) aneurysms were the most commonly identified aneurysms. There were 21 (20.2%) patients with aneurysms in multiple vascular beds, 9 (8.7%) patients with saccular aneurysms, 1 (1.0%) mycotic aneurysm, and 1 (1.0%) inflammatory aneurysm. The mean age at time of diagnosis was 57.7 ± 10.3 years, 80.8% of patients were male, and 32.0% had a history of AIDS. The average time from HIV diagnosis to aneurysm diagnosis was 14.1 ± 10.1 years. There were six ruptures, one dissection, and one thrombosis (descending aortic, iliac, subclavian, cerebral, ascending aortic, popliteal). There were 26 (25.0%) patients who underwent repair of their aneurysms, with the most common repair being an endovascular aneurysm repair in nine patients for an abdominal aortic aneurysm, and cerebral aneurysm repair in six patients. Although aneurysmal disease was widespread, the majority of HIV-positive patients had large-vessel aneurysms in this study. Patients were more likely to have saccular and multiple aneurysms compared to historical controls, repair was associated with good perioperative outcomes. Additional studies are necessary to characterize this rare entity.TableCharacteristics of HIV-positive patients (n = 104) with aneurysmal diseaseCharacteristicsMean ± SD or No. (%)Demographics and comorbidities Age, years57.7 ± 10.3 Male84 (80.8) RaceCaucasian58 (56.3)African American36 (35.0)Hispanic9 (8.7) Coronary artery disease44 (42.3) Myocardial infarction24 (23.1) Hypertension80 (76.9) Congestive heart failure18 (17.3) Chronic obstructive pulmonary disorder16 (15.4) Hyperlipidemia69 (66.4) Hepatitis B16 (15.4) Hepatitis C24 (23.3) Cirrhosis8 (7.8) Stroke16 (15.7) Chronic kidney disease25 (24.5) Smoking statusNever28 (27.2)Former33 (32.0)Current42 (40.8) Mean CD4 count495.9 ± 474.23 Mean viral load11,052.4 ± 33,207.1 History of AIDS33 (32.0) History of illicit drug use25 (24.0) Time to aneurysm diagnosis, years14.1 ± 10.1Medications NRTI89 (85.6) NNRTI24 (23.01) PI34 (32.7) INSTI56 (53.9)Aneurysm characteristics Aneurysm typeAscending aortic45 (43.3)Descending aortic14 (13.5)Abdominal aortic23 (22.1)Iliac7 (6.7)Visceral4 (3.9)Lower extremity3 (2.9)Subclavian3 (2.9)Carotid1 (1.0)Cerebral12 (11.5)Coronary1 (1.0)Saccular9 (8.7)Multiple aneurysms21 (20.2) Type of imagingCT66 (64.7)Ultrasound30 (29.4)MRI5 (4.9)PET1 (1.0)CT, Computed tomography; INSTI, integrase strand transcriptase inhibitor; MRI, magnetic resonance imaging; NRTI, nucleoside reverse transcriptase inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; PET, positron emission tomography; PI, protease inhibitor; SD, standard deviation. Open table in a new tab