Association of HIV Serostatus and Inflammation With Ascending Aortic Size

Abstract

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.

Keywords: HIV; aneurysm; aorta; echocardiography; inflammation; vascular disease.

Figures

Figure 1. Adjusted associations between HIV serostatus and aortic sizes.

Adjusted for age, race and ethnicity, education level, MACS (Multicenter AIDS Cohort Study) site, enrollment period (pre/post 2001), and cardiovascular disease risk factors (heart rate, systolic blood pressure, hypertensive medication use, diabetes, dyslipidemia, smoking history, alcohol use, ever cocaine use, statin use, and history of cardiovascular events). Diabetes is defined as glycosylated hemoglobin ≥6.5% or fasting glucose ≥126 mg/dL or use of diabetes medications. Dyslipidemia is defined as fasting total cholesterol ≥200 mg/dL or low‐density lipoprotein ≥130 mg/dL or high‐density lipoprotein ≤40 mg/dL or use of lipid‐lowering medication. History of cardiovascular events is defined as personal history of heart failure, myocardial infarction, cerebrovascular accident, or atrial fibrillation.

Figure 2. Adjusted associations between CD4 (cluster of differentiation 4) count, viral load, and inflammatory biomarker levels with aortic sizes among men with HIV (MWH).

Figure shows adjusted associations (regression coefficients, 95% CI) of nadir CD4 cell count, undetectable viral load at the visit, persistently undetectable viral load within the preceding 5 years of echocardiogram, and inflammatory markers, with aortic sizes among MWH. Adjusted for age, race and ethnicity, education level, MACS (Multicenter AIDS Cohort Study) site, enrollment period (pre/post 2001), and cardiovascular disease risk factors (heart rate, systolic blood pressure, hypertensive medication use, diabetes, dyslipidemia, smoking history, alcohol use, ever cocaine use, statin use, and history of cardiovascular events). Diabetes is defined as glycosylated hemoglobin ≥6.5% or fasting glucose ≥126 mg/dL or use of diabetes medications. Dyslipidemia is defined as fasting total cholesterol ≥200 mg/dL or low‐density lipoprotein ≥130 mg/dL or high‐density lipoprotein ≤40 mg/dL or use of lipid lowering medication. History of cardiovascular events is defined as personal history of heart failure, myocardial infarction, cerebrovascular accident, or atrial fibrillation. hs‐CRP indicates high‐sensitivity C‐reactive protein; IL‐6, interleukin‐6; and TNF‐α, tumor necrosis factor‐α.