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Mokotjo M, Woodiwiss AJ, Mogaladi S, Hasenkam JM, Meel R. Evaluation of aortic wall strength in human immunodeficiency virus associated thoracic ascending aortic aneurysm: a pilot study. Cardiovasc Diagn Ther 2023; 13:929-938. [PMID: 38162102 PMCID: PMC10753234 DOI: 10.21037/cdt-23-188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/15/2023] [Indexed: 01/03/2024]
Abstract
Background Human immunodeficiency virus (HIV) associated aortopathy is associated with considerable morbidity and mortality. The pathophysiology of aortic wall strength in HIV thoracic aortic aneurysm has not been studied. Methods The patients with HIV associated thoracic ascending aortic aneurysm (TAAA) were enrolled in the study and underwent surgery as part of their routine management. We compared collagen quantity in aneurysmal and non-aneurysmal aortic tissue in TAAA with regards to hydroxyproline concentration as a surrogate measure for collagen content and sent aneurysmal aorta for routine clinical histological assessment. This data was analysed to identify potential relations between aortic aneurysm formation and the collagen content of the aortic wall. Results The study included 12 patients with HIV aortopathy (9 females, median age 49 years). In total 33 tissue samples were investigated (14 aneurysmal, 13 non-aneurysmal aortic tissue and 6 aortic leaflets). There was no difference in hydroxyproline concentration of aneurysmal aortic tissue and seemingly normal tissue [19.40 (15.19-22.98) vs. 20.85 (15.55-25.83) µg/mg; P=0.82]. No difference was noted in hydroxyproline concentration among aneurysmal, seemingly normal aortic tissue and aortic valve leaflets [19.40 (15.19-22.98) vs. 20.85 (15.55-25.83) vs. 19.09 (13.94-22.00) µg/mg; P=0.86]. Histology showed fragmentation of elastin fibres in 50% of the cases. Conclusions No difference in collagen concentration in the aneurysmal and non-aneurysmal aortic tissue was noted. However, most of the aneurysmal tissue had fragmentation of elastin fibres.
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Affiliation(s)
- Moleboheng Mokotjo
- Department of Surgery, Division of Cardiothoracic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J. Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Shungu Mogaladi
- Department of Surgery, Division of Cardiothoracic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - J. Michael Hasenkam
- Department of Surgery, Division of Cardiothoracic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ruchika Meel
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Unice T, Naidoo P, Hiralal P, Naidoo Y, Pillay S. Multiple fusiform and saccular aneurysms in a person living with Human Immunodeficiency Virus. SAGE Open Med Case Rep 2023; 11:2050313X231211048. [PMID: 38022860 PMCID: PMC10656792 DOI: 10.1177/2050313x231211048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Cerebral aneurysms secondary to human immunodeficiency virus vasculopathy are a diagnosis by exclusion and its mechanism is unknown. We report on a 21-year-old male with human immunodeficiency virus infection and suboptimal virological control, despite highly active antiretroviral therapy. An incidental discovery of multiple cerebral aneurysms occurred in this patient, who initially presented with signs of disorientation, acute psychosis, and a history of blunt cranial trauma. A non-contrasted computerized tomography scan of the encephalon showed no intracranial hemorrhage but multiple cerebral (saccular and fusiform) aneurysms. Subsequently, a non-urgent computerized tomography angiogram of the cerebral vasculature corroborated the existence of multiple cerebral aneurysms. Despite investigation, no secondary etiological factors for the aneurysmal condition were identified. The multitude of cerebral aneurysms was consequently ascribed to human immunodeficiency virus-associated vasculopathy. The patient was managed conservatively. At discharge, he was lucid and apsychotic. A unique aspect of the case is the presence of both fusiform and saccular cerebral aneurysms.
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Affiliation(s)
- Talia Unice
- King Edward VIII Hospital, Durban, Kzn, South Africa
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3
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Cavalcante MG, Gomes PEADC, Parente MDSR, Meneses GC, Silva Junior GBD, Neto RDJP, Martins AMC, Daher EDF. Monitoring Renal Function in HIV Patients Without Kidney Disease Using Endothelial Biomarkers: A Prospective Pilot Study. AIDS Res Hum Retroviruses 2023; 39:468-474. [PMID: 36924277 DOI: 10.1089/aid.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
This study aimed to investigate the association between novel biomarkers and renal injury in people with HIV (PWH). A cohort study was carried out with PWH under chronic use of antiretroviral therapy (ART), followed at a public outpatient service. Clinical and laboratory parameters of the patients were evaluated year by year, from 2015 [at baseline (year 1, Y1)] to 2019 [year 5 (Y5)]. At baseline, biomarkers of renal damage (e.g., neutrophil gelatinase-associated lipocalin-NGAL, monocyte chemoattractant protein-1-MCP-1, and kidney injury molecule-1-KIM-1) and endothelial activation or glycocalyx damage [e.g., intercellular adhesion molecule 1 (ICAM-1), E-selectin, and syndecan-1] were quantified using enzyme-linked immunosorbent assays and their levels were used to classify patients into different groups. However, only syndecan-1 showed a significant correlation with serum creatinine (p < .001) and glomerular filtration rate (GFR) (p = .003) over the years. Moreover, both serum creatinine and GFR in almost 5 years were significantly associated with serum levels of syndecan-1 at baseline. The multivariate linear regression with confounders showed a significant and independent association between GFR and levels of syndecan-1 and CD4 cell count in the beginning of the study, as well as age in Y5. The data reinforce the screening for kidney diseases with novel biomarkers, especially syndecan-1, as an important strategy for a timely diagnostic and therapeutic approach.
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4
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Meel R, Hasenkam M, Goncalves R, Blair K, Mogaladi S. Spectrum of ascending aortic aneurysms at a peri-urban tertiary hospital: an echocardiography-based study. Front Cardiovasc Med 2023; 10:1209969. [PMID: 37492155 PMCID: PMC10363745 DOI: 10.3389/fcvm.2023.1209969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Thoracic ascending aortic (TAA) aneurysms are an important cause of disability and death and require early detection for effective management. Currently, there is a paucity of data from Africa pertaining to TAA aneurysms. This study describes the spectrum of TAA aneurysms at a peri-urban tertiary hospital. Methods A descriptive retrospective study based on clinical and echocardiographic imaging data of patients with TAA aneurysms from October 2017-October 2022. Advanced strain imaging was performed to measure left ventricular (LV) basal, apical, and global longitudinal strain as well as circumferential strain (CS) of the ascending aorta as a proxy measurement of aortic compliance. Results The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50 ± 14.8 years with 45 age and gender matched controls. Most cases (95%) were of African ethnicity. The main etiologies were hypertension (41.7%), HIV (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies (8.6%). Two-thirds of patients (69.7%) presented in heart failure, 10% presented with aortic dissection. Thirty percent of the patients were classified as New York Heart Association (NYHA) class I, 59.7% NYHA II, 8.6% NYHA III and two patients NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P < 0.001). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of patients, moderate AR in 25.8%, and mild AR in 14.3%. The mean LV ejection fraction (46.9 ± 12.7%) was reduced compared to controls (P < 0.001). Aortic CS was reduced compared to controls [4.4 (3.2-6.2) % vs. 9.0 (7.1-13.4) %, P < 0.001]. Aortic stiffness was higher in the aortic aneurysm group compared to controls (15.39 ± 20.65 vs. 5.04 ± 2.09, P = 0.001). LV longitudinal strain (-13.9 ± 3.9% vs. 18.1 ± 6.7%), basal CS (-13.9 ± 5.6% vs. -17.9 ± 5.8%) and apical CS (-8.7 ± 8.5% vs. -30.6 ± 3.8%) were reduced compared to controls (P < 0.001). Most patients were on diuretic and anti-remodeling therapy. Surgery was performed in 29.4% and overall mortality was 7.9%. Mortality for acute aortic dissection was 40%. Conclusion TAA aneurysms associated with hypertension and HIV are common in this predominantly African female population and are associated with considerable morbidity and mortality. Two-dimensional echocardiography and advanced strain imaging are potential tools for detecting and risk stratifying TAA aneurysms.
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Affiliation(s)
- Ruchika Meel
- Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Kelly Blair
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Shungu Mogaladi
- Division of Cardiothoracic Surgery, Department of General Surgery, Charlotte Maxeke Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Khan RM, Najam US, Cheikh Debs DA, Myers J, Graham S. HIV-Positive Patient With Non-Percutaneous Coronary Intervention (PCI)-Amenable Left Coronary Artery Aneurysms Presenting With ST-Elevation Myocardial Infarction (STEMI). Cureus 2023; 15:e36703. [PMID: 37113349 PMCID: PMC10128888 DOI: 10.7759/cureus.36703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 03/28/2023] Open
Abstract
Human immunodeficiency virus (HIV) was first reported in the early 1980s and a once untreatable and fatal disease has since allowed individuals to live healthy lives with the advent of novel antiviral medications. While the life expectancy of an HIV-positive individual has dramatically increased, a myriad of HIV-related complications such as pneumocystis pneumonia, candidiasis, renal disease, anxiety/depression, and cardiovascular disease have dramatically decreased. However, these patients are still prone to complex medical problems. In this case report, we aim to highlight a rare, complicated case of an HIV-positive patient with coronary artery aneurysms complicated by an ST-elevation myocardial infarction (STEMI).
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Kasenda S, Crampin A, Davies J, Malava JK, Manganizithe S, Kumambala A, Sandford B. Prevalence and risk factors of lower extremity disease in high risk groups in Malawi: a stratified cross-sectional study. BMJ Open 2022; 12:e055501. [PMID: 35948375 PMCID: PMC9379496 DOI: 10.1136/bmjopen-2021-055501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Low/middle-income countries face a disproportionate burden of cardiovascular diseases. However, among cardiovascular diseases, burden of and associations with lower extremity disease (LED) (peripheral arterial disease and/or neuropathy) is neglected. We investigated the prevalence and factors associated with LED among individuals known to have cardiovascular disease risk factors (CVDRFs) in Malawi, a low-income country with a significant prevalence of CVDRFs. DESIGN This was a stratified cross-sectional study. SETTING This study was conducted in urban Lilongwe Area 25, and the rural Karonga Health and Demographic Surveillance Site. PARTICIPANTS Participants were at least 18 years old and had been identified to have two or more known CVDRFs. MAIN OUTCOME MEASURES LED-determined by the presence of one of the following: neuropathy (as assessed by a 10 g monofilament), arterial disease (absent peripheral pulses, claudication as assessed by the Edinburgh claudication questionnaire or Ankle Brachial Pulse Index (ABPI) <0.9), previous amputation or ulceration of the lower limbs. RESULTS There were 806 individuals enrolled into the study. Mean age was 52.5 years; 53.5% of participants were men (n=431) and 56.7% (n=457) were from the rural site. Nearly a quarter (24.1%; 95% CI: 21.2 to 27.2) of the participants had at least one symptom or sign of LED. 12.8% had neuropathy, 6.7% had absent pulses, 10.0% had claudication, 1.9% had ABPI <0.9, 0.9% had an amputation and 1.1% had lower limb ulcers. LED had statistically significant association with increasing age, urban residence and use of indoor fires. CONCLUSIONS This study demonstrated that a quarter of individuals with two or more CVDRFs have evidence of LED and 2.4% have an amputation or signs of limb threatening ulceration or amputation. Further epidemiological and health systems research is warranted to prevent LED and limb loss.
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Affiliation(s)
- Stephen Kasenda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Justine Davies
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Annie Kumambala
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Becky Sandford
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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7
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Risk of subarachnoid haemorrhages and aneurysms in Danish People Living With HIV, a nationwide cohort study. AIDS 2022; 36:1287-1294. [PMID: 35471643 DOI: 10.1097/qad.0000000000003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It remains unclear whether people with HIV (PWH) have increased risk of aneurysms. We aimed to investigate if the risk of subarachnoid haemorrhage, cerebral aneurysm, aortic aneurysm and other arterial aneurysms and dissections is increased in PWH compared with the general population. DESIGN We performed a nationwide population-based matched cohort study. METHODS We compared PWH with age-matched and sex-matched comparison cohort members to calculate incidence rate ratios (IRR) of subarachnoid haemorrhage, cerebral aneurysm, aortic aneurysm and other arterial aneurysms and dissections as well as surgery for these conditions. RESULTS We included all PWH, who were Danish residents and treated at a HIV healthcare centre between January 1995 and February 2018 (n = 6935) and an age-matched and sex-matched comparison cohort (n = 55 480). PWH had increased risk of subarachnoid haemorrhage (IRR 1.7, 95% CI, 1.1-2.6), but no increased risk of surgery for this condition. PWH had no increased risk of cerebral aneurysm or aortic aneurysm or surgery for these conditions. The risk of other arterial aneurysms and dissections was increased in PWH (IRR 2.0, 95% CI, 1.4-2.9), but this only applied for PWH who reported intravenous substance use as route of HIV transmission (IRR 18.4, 95% CI, 9.3-36.6), and not for PWH without reported injection drug use (IRR 1.2, 95% CI, 0.73-1.7). CONCLUSION PWH were not at an increased risk of cerebral, aortic or other arterial aneurysms and dissections. Although PWH were at an increased risk of subarachnoid haemorrhage, subarachnoid haemorrhages were rare among PWH.
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8
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Minhas AS, Post WS, Liu B, Doria De Vasconcellos H, Haberlen SA, Feinstein M, Stosor V, Budoff M, Chew KW, Magnani JW, Brown T, Lima JAC, Wu KC. Association of HIV Serostatus and Inflammation With Ascending Aortic Size. J Am Heart Assoc 2022; 11:e023997. [PMID: 35253450 PMCID: PMC9075303 DOI: 10.1161/jaha.121.023997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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.
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Affiliation(s)
- Anum S. Minhas
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Wendy S. Post
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD,Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMD
| | - Bin Liu
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMD
| | | | - Sabina A. Haberlen
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMD
| | - Matthew Feinstein
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Valentina Stosor
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Matthew Budoff
- Lundquist Institute at Harbor‐University of California Los Angeles Medical CenterTorranceCA
| | - Kara W. Chew
- Division of Infectious DiseasesDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCA
| | - Jared W. Magnani
- Division of CardiologyDepartment of MedicineUniversity of PittsburghPittsburghPA
| | - Todd Brown
- Division of Endocrinology and MetabolismDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Joao A. C. Lima
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Katherine C. Wu
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
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9
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Newcomer JB, Chishti EA, Raissi D. Endovascular management of HIV vasculopathy. J Clin Imaging Sci 2022; 12:9. [PMID: 35242452 PMCID: PMC8888187 DOI: 10.25259/jcis_226_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/11/2022] [Indexed: 11/04/2022] Open
Abstract
HIV is a multisystem disease process that can affect the cardiovascular system resulting in vasculopathy. As highly active anti-retroviral therapy has allowed patients to live longer with the disease, vascular complications such as aneurysms, occlusive disease, spontaneous arteriovenous fistulae, and arterial dissections have been described. The pathogenesis of vascular-related complications in HIV is poorly understood but is thought to involve an interplay between viral-induced inflammation, vascular smooth muscle changes, endothelial alterations, and circulating blood factors. The most well-described management strategies for symptomatic aneurysm-related complications are surgical in nature, with mostly anecdotal reports of endovascular intervention. We present a case of a 24-year-old male who was found to have findings consistent with HIV vasculopathy on angiography after presenting with acute GI hemorrhage secondary to left gastric artery bleeding. Our patient was managed with endovascular embolization. Although studies have shown promise regarding the endovascular management of HIV-related aneurysmal complications in the short term, more research is needed to evaluate the long-term success of these interventions.
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Affiliation(s)
- Jack B. Newcomer
- University of Kentucky College of Medicine, Lexington, Kentucky, United States,
| | - Emad A. Chishti
- University of Kentucky College of Medicine, Lexington, Kentucky, United States,
| | - Driss Raissi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky, Lexington, Kentucky, United States,
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10
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Theofilis P, Vordoni A, Koukoulaki M, Vlachopanos G, Kalaitzidis RG. Overview of infections as an etiologic factor and complication in patients with vasculitides. Rheumatol Int 2022; 42:759-770. [PMID: 35165771 PMCID: PMC8853270 DOI: 10.1007/s00296-022-05100-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Aikaterini Vordoni
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Maria Koukoulaki
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Georgios Vlachopanos
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology "G. Papadakis", General Hospital of Nikaia-Piraeus "Agios Panteleimon", 18454, Piraeus, Nikaia, Greece.
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11
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Contemporary management of infective native aortic aneurysms. Curr Opin Cardiol 2021; 36:689-694. [PMID: 34456251 DOI: 10.1097/hco.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Infective native aortic aneurysms (INAAs) are challenging and complex with both bacteraemia and an aneurysm prone to rupture. They are fatal unless recognized and treated promptly. The rarity of the disease makes it unfamiliar to most physicians, which might delay both diagnosis and treatment.The present review aims to outline the recently published diagnostic algorithm of INAAs, the main characteristics of the disease and present an overview of contemporary treatment strategies. RECENT FINDINGS New terminology, definition, diagnostic algorithm and reporting standards have recently been proposed for INAAs. Current evidence concerning the treatment of INAAs is founded on retrospective register-based multicentre studies and small single-centre studies. Recent findings encourage the use of endovascular aortic repair (EVAR) for surgical treatment of INAAs. Although EVAR, as a surgical approach, does not drain the infection, the postoperative infection-related complication rates (IRCs) are similar to the ones reported after open surgical repair (OSR) with aortic prosthetic reconstruction and extensive debridement. IRCs carry over 50% risk of being fatal. Postoperative mortality after EVAR remains considerably lower supporting the use of method for aged and comorbid group of patients. Biological grafts have the benefit of being more resistant to reinfection. OSR with biological reconstruction is a promising surgical approach for patients fit for open surgery; however, data are scarce and long-term follow-up is lacking. SUMMARY The treatment of INAAs should be guided by experienced multidisciplinary team and tailored individually based on patients' condition and centres' experience. An international consensus document is warranted to enable further research on this disease.
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12
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West-Livingston LN, Dittman JM, Park JA, Pascarella L. Sexual orientation, gender identity, and gender expression: From current state to solutions for the support of lesbian, gay, bisexual, transgender, and queer/questioning patients and colleagues. J Vasc Surg 2021; 74:64S-75S. [PMID: 34303461 DOI: 10.1016/j.jvs.2021.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/23/2021] [Indexed: 01/16/2023]
Abstract
Many of the systemic practices in medicine that have alienated lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals persist today, undermining the optimal care for these patients and isolating LGBTQ medical providers from their colleagues. The 2020 Task Force on Diversity, Equity, and Inclusion Report recently published by the Society for Vascular Surgery marked the first publication advocating for the inclusion of sexual orientation and sexual identity in the development of initiatives promoting and protecting diversity across vascular surgery. Vascular providers should be aware that it is crucial to cultivate an environment that is inclusive for LGBTQ patients because a large proportion of these patients have reported not self-disclosing their status to medical providers, either out of concern over potential personal repercussions or failing to recognize the potential relevance of LGBTQ status to their medical care. Safe Zone training has provided a standard resource for providers and staff that can be integrated into onboarding and routine training. Clarifying the current terminology for sexual orientation and identity will ensure that vascular providers will recognize patients who could benefit from screening for additional vascular risk factors relevant to this population related to sexual health, social behavior, physical health, and medical therapies. The adoption of gender neutral language on intake forms and general correspondence with colleagues is key to reducing the unintended exclusion of those with LGBTQ identities in both inpatient and outpatient environments. In many locales across the United States, the professional and personal repercussions for openly reporting LGBTQ status persist, complicating efforts toward quantifying, recognizing, and supporting these patients, practitioners, and trainees. Contributing to an inclusive environment for patients and peers and acting as a professional ally are congruent with the ethos in vascular surgery to treat all patients and colleagues with respect and optimize the healthcare of every vascular patient.
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Affiliation(s)
| | - James M Dittman
- Virginia Commonwealth University School of Medicine, Richmond, Va
| | - Jason A Park
- Boston University School of Medicine, Boston, Mass
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
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13
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Rasile M, Lauranzano E, Mirabella F, Matteoli M. Neurological consequences of neurovascular unit and brain vasculature damages: potential risks for pregnancy infections and COVID-19-babies. FEBS J 2021; 289:3374-3392. [PMID: 33998773 PMCID: PMC8237015 DOI: 10.1111/febs.16020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
Intragravidic and perinatal infections, acting through either direct viral effect or immune-mediated responses, are recognized causes of liability for neurodevelopmental disorders in the progeny. The large amounts of epidemiological data and the wealth of information deriving from animal models of gestational infections have contributed to delineate, in the last years, possible underpinning mechanisms for this phenomenon, including defects in neuronal migration, impaired spine and synaptic development, and altered activation of microglia. Recently, dysfunctions of the neurovascular unit and anomalies of the brain vasculature have unexpectedly emerged as potential causes at the origin of behavioral abnormalities and psychiatric disorders consequent to prenatal and perinatal infections. This review aims to discuss the up-to-date literature evidence pointing to the neurovascular unit and brain vasculature damages as the etiological mechanisms in neurodevelopmental syndromes. We focus on the inflammatory events consequent to intragravidic viral infections as well as on the direct viral effects as the potential primary triggers. These authors hope that a timely review of the literature will help to envision promising research directions, also relevant for the present and future COVID-19 longitudinal studies.
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Affiliation(s)
- Marco Rasile
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Filippo Mirabella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Michela Matteoli
- IRCCS Humanitas Clinical and Research Center, Rozzano, Italy.,CNR Institute of Neuroscience, Milano, Italy
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14
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Maningding E, Kermani TA. Mimics of vasculitis. Rheumatology (Oxford) 2021; 60:34-47. [PMID: 33167039 DOI: 10.1093/rheumatology/keaa495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/07/2020] [Accepted: 07/06/2020] [Indexed: 11/14/2022] Open
Abstract
While prompt diagnosis of vasculitis is important, recognition of vasculitis mimics is equally essential. As in the case of vasculitis, an approach to mimics based on the anatomic size of vessels can be useful. Infections can mimic vasculitis of any vessel size, including the formation of aneurysms and induction of ANCAs. Genetic disorders and vasculopathies are important considerations in large and medium vessel vasculitis. Cholesterol emboli, thrombotic conditions and calciphylaxis typically affect the medium and small vessels and, like vasculitis, can cause cutaneous, renal and CNS manifestations. Reversible cerebral vasoconstriction syndrome is important to distinguish from primary angiitis of the CNS. As an incorrect diagnosis of vasculitis can result in harmful consequences, it is imperative that the evaluation of suspected vasculitis includes consideration of mimics. We discuss the above mimics and outline a systematic and practical approach for differentiating vasculitis from its mimics.
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Affiliation(s)
- Ernest Maningding
- Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tanaz A Kermani
- Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, USA
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15
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Review of the neurological aspects of HIV infection. J Neurol Sci 2021; 425:117453. [PMID: 33895464 DOI: 10.1016/j.jns.2021.117453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
There are almost 40 million people in the world who live with the human immunodeficiency virus (HIV). The neurological manifestations associated with HIV contribute to significant morbidity and mortality despite the advances made with anti-retroviral therapy (ART). This review presents an approach to classification of neurological disorders in HIV, differentiating diseases due to the virus itself and those due to opportunistic infection. The effects of antiretroviral therapy are also discussed. The emphasis is on the developing world where advanced complications of HIV itself and infections such as tuberculosis (TB), toxoplasmosis and cryptococcal meningitis remain prevalent.
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16
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Roman S, Mekheal N, Tal S, Michael P. More Than Just an Ulcer: A Case of HIV-Associated Iliac Aneurysms Presenting With a Leg Ulcer. Cureus 2021; 13:e13203. [PMID: 33717743 PMCID: PMC7943397 DOI: 10.7759/cureus.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The incidence of symptomatic vasculitis in human immunodeficiency virus (HIV)-infected patients is approximately 1%, and it commonly presents as arterial occlusive disease or aneurysmal disease. Early diagnosis of vascular complications in those patients is essential; however, it is extremely challenging. Iliac aneurysms are usually silent, and because of their deep location, detection of these aneurysms is typically difficult. Therefore, they always continue to be asymptomatic until rupture unless they are discovered incidentally on a radiological investigation for an irrelative condition. We present the case of a 61-year-old HIV-positive man with bilateral iliac aneurysms and total coronary artery occlusion presenting with a leg ulcer.
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Affiliation(s)
- Sherif Roman
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Nader Mekheal
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Shani Tal
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Patrick Michael
- Internal Medicine, St. Joseph's Univeristy Medical Center, Paterson, USA
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17
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Salman R, Masand P, Huisman TA, Pereira M, Kearney DL, Guillerman RP, Jadhav S. A Novel Large-Vessel Arteritis in SARS-CoV-2-Related Multisystem Inflammatory Syndrome in Children (MIS-C). Radiol Cardiothorac Imaging 2021; 3:e200535. [PMID: 33778663 PMCID: PMC7798125 DOI: 10.1148/ryct.2020200535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a newly defined condition associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The syndrome has been described as a "Kawasaki disease"-like illness and the spectrum of associated abnormalities, including vascular complications, remain to be fully defined. The novel findings of a large-vessel arteritis in this report will add to the understanding of this syndrome and its associated vascular complications.
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Affiliation(s)
- Rida Salman
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
| | - Prakash Masand
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
| | - Thierry A.G.M. Huisman
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
| | - Maria Pereira
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
| | - Debra Lynn Kearney
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
| | - R. Paul Guillerman
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
| | - Siddharth Jadhav
- Baylor College of Medicine Edward B. Singleton Department of Radiology, Texas Children's Hospital(R.S., P.M., T.A.G.M.H., R.P.G., S.J.); Baylor College of Medicine Department of Pediatrics, Division of Rheumatology(M.P.); Baylor College of Medicine Department of Pathology & Immunology(D.L.K.)
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18
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Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol 2020; 18:331-348. [PMID: 33353985 DOI: 10.1038/s41569-020-00472-6] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
The aorta is the 'greatest artery', through which oxygenated blood is delivered from the left ventricle to end organs with each cardiac cycle (200 million litres of blood transported in an average lifetime). The aorta can be affected by a wide spectrum of acute factors (such as cocaine use, weight lifting and trauma) and chronic acquired and/or genetic conditions (such as systemic arterial hypertension and phaeochromocytoma), which variously lead to increased aortic wall stress. The medial layer of the aorta can also be subject to abnormalities (such as Marfan syndrome, bicuspid aortic valve, inflammatory vasculitis, atherosclerosis and infections). Despite important advances in diagnostic and therapeutic interventions, data derived from registries and population-based studies highlight that the burden of aortic diseases remains high. Therefore, specific resources need to be allocated to design and implement preventive strategies (healthy lifestyles, modifications to cardiovascular risk factors, and educational and screening programmes) at individual and community levels. In this Review, we discuss the epidemiology, management and outcomes of the most common aortic diseases, namely, aortic aneurysms and acute aortic syndromes.
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19
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Abstract
Purpose of Review To review the spectrum of vasculitides in HIV-infected patients and to identify the clinical features that characterize vasculitis in sero-positive HIV. Recent Findings Epidemiological studies conducted in the post-HAART era described the rarity of vasculitis in the setting of HIV-infected patients. A study identified histopathological features such as leukocytoclastic vasculitis of the vasa vasorum and adventitial inflammation in the large artery pathology of HIV-positive patients compared with HIV-negative patients with critical lower limb ischemia. A recent retrospective cohort study reported that HIV-positive patients with LVV developed more vascular complications, responded less to antiretroviral therapy, and had worse outcome than HIV-negative patients with LVV. Summary Vasculitides continue to be a rare disease in patients with HIV. The spectrum of vasculitis ranges from life-threatening conditions to relatively mild skin conditions. Recognizing vasculitis in the setting of HIV-positive patients is important because sometimes it require immunosuppressive treatment.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Central Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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20
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Tijani Y, Belmir H, Zahdi O, Hormat-Allah M, El Bhali H, El Khloufi S, Sefiani Y, El Mesnaoui A, Lekehal B. [Occlusion of the abdominal aorta in patients infected with the human immunodeficiency virus: Clinical case and review of the literature]. Ann Cardiol Angeiol (Paris) 2020; 69:210-212. [PMID: 32800316 DOI: 10.1016/j.ancard.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
HIV infection has now become a chronic disease with a good life expectancy thanks to antiretrovirals. The mortality currently is attributed to other pathologies in particular cardiovascular because of the inflammation and the side effects of the drugs. All arteries can be damaged in HIV, especially the aorta, with several types of lesions which can be occlusive, aneurysmal, dissecting, even with the cases of arteriovenous fistula which have been described. HIV occlusive arterial disease is different from atheromatous disease in HIV-free patients and this is confirmed by pathology and ultrasound studies, which makes it more difficult to manage HIV-related occlusions. The open surgical treatment especially in the acute forms is disappointing with complications of rethrombosis and infectious and of sepsis of prosthesis considering the immunosuppression, the endovascular treatment begins to become the treatment of choice in the aneurysmal pathology and probably it would be in the future for occlusive disease.
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Affiliation(s)
- Y Tijani
- Service de chirurgie vasculaire et endovasculaire. Groupe hospitalier de l'université Mohammed VI des sciences de la santé, . Mohammed VI university of health sciences (UM6SS), . Casablanca, Maroc.
| | - H Belmir
- Service de chirurgie vasculaire et endovasculaire. Groupe hospitalier de l'université Mohammed VI des sciences de la santé, . Mohammed VI university of health sciences (UM6SS), . Casablanca, Maroc
| | - O Zahdi
- Université Mohammed V de Rabat.Rabat. Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
| | - M Hormat-Allah
- Université Mohammed V de Rabat.Rabat. Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
| | - H El Bhali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
| | - S El Khloufi
- Université Mohammed V de Rabat.Rabat. Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
| | - Y Sefiani
- Université Mohammed V de Rabat.Rabat. Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
| | - A El Mesnaoui
- Université Mohammed V de Rabat.Rabat. Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
| | - B Lekehal
- Université Mohammed V de Rabat.Rabat. Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, 10104 Souissi, Rabat, Maroc
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21
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Kim TI, Hessel K, Orion KC. Patient Characteristics, Patterns, and Repair of Aneurysms in Human Immunodeficiency Virus-Positive Patients. Ann Vasc Surg 2020; 70:393-400. [PMID: 32599105 DOI: 10.1016/j.avsg.2020.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a multisystem disease and is associated with vascular complications including aneurysm formation. HIV-associated aneurysms are well documented and may present in unusual locations with concerning features. However, the literature regarding aneurysms in HIV-positive patients is limited to case series with limited data regarding aneurysm patterns. Furthermore, several small series have documented poor outcomes with surgical repair. Thus, our aim was to investigate the characteristics, patterns, and repair of aneurysms in HIV-positive patients in a multicenter study. METHODS All patients with a diagnosis of aneurysms and HIV were retrospectively identified from 2013 to 2018 across 2 institutions. Comorbidities, HIV-related characteristics, aneurysm characteristics, and repair were reviewed. RESULTS There were a total of 104 HIV-positive patients with 129 aneurysms. The mean age at the time of diagnosis was 57.7 ± 10.3 years, 80.8% of patients were male, and 32.0% had a history of acquired immunodeficiency syndrome. The average time from HIV diagnosis to aneurysm diagnosis was 14.1 ± 10.1 years. There were 53 (41.1%) ascending aortic, 25 (19.4%) abdominal aortic, 14 (10.9%) cerebral artery aneurysms, 13 (10.1%) descending thoracic, 9 (7.0%) iliac, 6 (4.7%) femoropopliteal, 4 (3.1%) visceral, 3 (2.9%) axillosubclavian, 1 (0.8%) carotid, and 1 (0.8%) coronary artery aneurysms. There were 23 (22.1%) patients with aneurysms in multiple vascular beds, 10 (9.6%) saccular aneurysms, and 1 (0.8%) inflammatory aneurysm. There were 7 ruptures (cerebral, descending thoracic, and iliac), 3 type A dissections (ascending aorta), and 1 thrombosis (popliteal). There were 26 (25.0%) patients who underwent surgical repair. This included 8 endovascular aneurysm repairs for abdominal aortic aneurysms, 6 endovascular coiling, clipping, and stent procedures for cerebral aneurysms, 4 open ascending aorta repairs, 2 bypasses for popliteal artery aneurysms, 2 endovascular stents for axillosubclavian artery aneurysms, 1 open descending aortic aneurysm repair, 1 endovascular aneurysm repair for an iliac aneurysm, 1 endovascular coiling for a renal artery aneurysm, and 1 open repair of a femoral artery aneurysm. Perioperative complications were common at 46.2%, although mortality was low at 3.8%. CONCLUSIONS Although aneurysms were widespread, most HIV-positive patients had large vessel aneurysms in this study. There was a high prevalence of saccular and multiple aneurysms, and repair was associated with low rates of mortality despite high rates of complications. Additional studies are necessary to characterize this rare entity.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Kara Hessel
- Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristine C Orion
- Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH.
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22
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Vega LE, Espinoza LR. Human immunodeficiency virus infection (HIV)-associated rheumatic manifestations in thepre- and post-HAART eras. Clin Rheumatol 2020; 39:2515-2522. [PMID: 32297034 PMCID: PMC7159285 DOI: 10.1007/s10067-020-05082-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
Rheumatic manifestations remain an important clinical manifestation associated to HIV. To date after 4 decades of the onset of the HIV/AIDS pandemic, almost 37 million individuals are living with the infection, including close to 2 million of newly infected individuals. The status, however, of a considerable proportion of HIV/AIDS patients has changed from a near fatal disorder secondary to opportunistic infections to a chronic disease in which renal cardiovascular, diabetes, malignancy, and autoimmune co-morbid disorders have become prevalent and relevant. In addition, the spectrum of rheumatic disorders also has changed since the introduction of HAART and its diagnosis and treatment represents a challenge. The purpose of this review is to define and discuss the HIV-related rheumatic manifestations in the pre- and post-HAART eras.
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Affiliation(s)
- Luis E Vega
- Section of Rheumatology, Air Force Hospital, Aramburú Ave 2nd block, Lima, Peru.
| | - Luis R Espinoza
- Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA, 70112, USA
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23
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Dominick L, Midgley N, Swart LM, Sprake D, Deshpande G, Laher I, Joseph D, Teer E, Essop MF. HIV-related cardiovascular diseases: the search for a unifying hypothesis. Am J Physiol Heart Circ Physiol 2020; 318:H731-H746. [PMID: 32083970 DOI: 10.1152/ajpheart.00549.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.
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Affiliation(s)
- Leanne Dominick
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Natasha Midgley
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa-Mari Swart
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Devon Sprake
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gaurang Deshpande
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ismail Laher
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danzil Joseph
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eman Teer
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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24
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Silvestri V, Borrazzo C, Mele R, d'Ettorre G. Carotid Artery Aneurysm in HIV: A Review of Case Reports in Literature. Ann Vasc Surg 2019; 63:409-426. [PMID: 31629845 DOI: 10.1016/j.avsg.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND HIV infection may affect the cardiovascular system through different physiopathological patterns. Rarely reported in HIV negative patients, aneurysms involving the carotid artery have been described for the first time in seropositive patients in 1989. AIMS In our study, we have focused on aneurysm pathology affecting carotid arteries in HIV patients, analyzing clinical and surgical presentation, management, and outcome, through a review of cases published in the literature. METHODS The MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "carotid artery aneurysm AND HIV OR AIDS OR immunodeficiency." RESULTS Nineteen articles including a total of 46 cases were included in our report. The mean age of patients was 30.6 ± 14.2 years; 30 patients (65.2%) were male. Aneurysms were localized in the intracranial carotid (41.3%) or extracranial artery (58%). Presenting features included symptoms due to compression of neck structures; positivity for neurological symptoms occurred in 36.9%. Patients were managed surgically in 58.7% of cases; surgical morbidity and mortality were of 22.2% and 7.4% respectively, higher for endovascular procedures. The overall mortality in treated and untreated cases was 26.1%. CONCLUSIONS Aneurysms may occur in both the extracranial and intracranial carotid artery in patients with HIV at younger age than in non-HIV patients and are linked to a high morbidity and mortality. Seropositivity must be ruled out whenever this rare vascular condition may occur in the absence of a more likely aetiology and must also be suspected in HIV patients presenting with compressive symptoms of the neck, neurological impairment or stroke.
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Affiliation(s)
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Italy
| | - Rita Mele
- Surgical Science Department, La Sapienza University, Roma, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Italy
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25
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Granja MF, Monteiro A, Day J, Hanel R. HIV vasculopathy versus VZV vasculitis in an HIV patient with multiple brain ischaemic infarcts. BMJ Case Rep 2019; 12:12/7/e229412. [PMID: 31315843 DOI: 10.1136/bcr-2019-229412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 56-year-old man who presented to the emergency department with a 3-day onset of left limb weakness and feeling intoxicated with poor balance. Stroke hospitalisations in the USA decreased from 2000 to 2010, however the number of hospitalised patients with ischaemic stroke and HIV infection has increased significantly. Herein, we discuss the management of this unique case to highlight the importance of a broad differential diagnosis when approaching HIV/AIDS patients presenting with acute or subacute neurological focalisation. Given that HIV vasculopathy is a diagnosis of exclusion, it requires a thoughtful elimination of all possible aetiologies.
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Affiliation(s)
- Manuel F Granja
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Andre Monteiro
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Jason Day
- Neurological Institute, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Ricardo Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
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26
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Mayne ES, Louw S. Good Fences Make Good Neighbors: Human Immunodeficiency Virus and Vascular Disease. Open Forum Infect Dis 2019; 6:ofz303. [PMID: 31737735 PMCID: PMC6847507 DOI: 10.1093/ofid/ofz303] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Cardiovascular disease, venous thrombosis, and microvascular disease in people with HIV (PWH) is predicted to increase in an aging HIV-infected population. Endothelial damage and dysfunction is a risk factor for cardiovascular events in PWH and is characterized by impaired vascular relaxation and decreased nitric oxide availability. Vascular disease has been attributed to direct viral effects, opportunistic infections, chronic inflammation, effects of antiretroviral therapy, and underlying comorbid conditions, like hypertension and use of tobacco. Although biomarkers have been examined to predict and prognosticate thrombotic and cardiovascular disease in this population, more comprehensive validation of risk factors is necessary to ensure patients are managed appropriately. This review examines the pathogenesis of vascular disease in PWH and summarizes the biomarkers used to predict vascular disease in this population.
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Affiliation(s)
- Elizabeth S Mayne
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service
| | - Susan Louw
- Department of Molecular Medicine Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
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27
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Silvestri V, D'Ettorre G, Borrazzo C, Mele R. Many Different Patterns under a Common Flag: Aortic Pathology in HIV-A Review of Case Reports in Literature. Ann Vasc Surg 2019; 59:268-284. [PMID: 31051229 DOI: 10.1016/j.avsg.2019.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Availability of highly active antiretroviral therapy (HAART) for HIV has prolonged life expectancy of patients but has also increased the incidence of non-AIDS comorbid conditions. Among these, there are cardiovascular diseases, and aortic involvement has been described in patients with HIV in the form of aortitis, aneurysms, or dissections. Our study aims to describe aortic pathology occurring in patients with HIV, focusing on clinical and surgical presentation, management, and outcome, through a review of cases published in literature. METHODS MEDLINE (www.ncbi.nlm.nih.gov/pubmed) database was reviewed for "aortitis" OR "aortic aneurysm" OR "aortic dissection" AND HIV. Research was restricted to English language. Only case reports were included. Data on patients' age, sex, traditional risk factors, timing from HIV diagnosis, pharmacological details, coinfection (syphilis, hepatitis C virus [HCV], and hepatitis B virus [HBV]), anatomical localization of lesion, presence of inflammatory involvement, rapid growing or rupture, and surgical treatment and outcomes were collected and summarized in tables. RESULTS Forty articles (51 cases) were included in the study. The mean age of patients was 48.8 ± 8.3 years. Male sex was preponderant (43 cases, 84.3%). Among traditional risk factors, hypertension and smoking were the most frequently reported ones (14 and 13 cases, respectively), followed by vasculopathy involving other arterial districts, dyslipidemia, diabetes, and drug addiction. In 3 cases, HIV was diagnosed in the same time as aortic pathology, whereas in most cases, aortic event occurred after five years from HIV diagnosis. In 30.5% of cases for which data on pharmacologic management were available, no treatment or poor adherence was reported. Coinfection occurred in some cases (syphilis in 6, HCV in 5, and HBV in 3). As for anatomical involvement, isolated thoracic lesions were more frequent (24, 47.1%), followed by abdominal and thoracoabdominal lesions. The etiology ranged from bacterial mycotic aneurysms to tertiary syphilis, postsurgical complications, or atherosclerosis. In 3 cases, HIV vasculitis was directly suggested, and in another 2, no other potential etiology had been diagnosed through cultural tests. Open surgical treatment was carried out in 30 cases (58.8%), and in addition, 10 endovascular (19.6%) and 2 hybrid procedures were described. Inflammatory features occurred in 7 cases, and a rapid evolution of lesions in 6. In 9 cases (17.6%), rupture occurred. Mortality was reported in 8 cases (15.7%). CONCLUSIONS Aortic pathology may occur in patients with HIV. The entanglement of different patterns of pathological involvement of the aortic wall, secondary to immune dysregulation, infectious process, or atherosclerotic damage that may co-occur in one single case, results in a very challenging management of the condition. Because of the increased life expectancy of patients and immigration from regions with both high HIV and coinfection prevalence, the incidence of aortic pathology could increase in the upcoming years, suggesting the urgent need for further studies to optimize management in these very complex cases.
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Affiliation(s)
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Rita Mele
- Surgical Science Department La Sapienza University, Roma, Italy
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Gerena Y, Menéndez-Delmestre R, Delgado-Nieves A, Vélez J, Méndez-Álvarez J, Sierra-Pagan JE, Skolasky RL, Henderson L, Nath A, Wojna V. Release of Soluble Insulin Receptor From Neurons by Cerebrospinal Fluid From Patients With Neurocognitive Dysfunction and HIV Infection. Front Neurol 2019; 10:285. [PMID: 30972014 PMCID: PMC6443904 DOI: 10.3389/fneur.2019.00285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/05/2019] [Indexed: 01/03/2023] Open
Abstract
Previously, we found that high levels of soluble insulin receptor (sIR) in the cerebrospinal fluid (CSF) of an HIV-infected women cohort were associated with the presence and severity of HIV-associated neurocognitive disorders (HAND). In this study we investigated if CSF from this population, HIV-1 Tat, and selected cytokines induces sIR secretion from human neuronal cells. Twenty-three (23) HIV-seropositive women stratified by cognitive status and five HIV- seronegative women were evaluated. Soluble IR levels were measured in the extracellular medium of neuronal cells (SH-SY5Y) that were exposed (for 24 h) to the CSF of patients. The levels of sIR, HIV-1 Tat, and cytokine levels (IL-2, IL4, IL-6, IFNγ, TNFα, and IL-10) were quantified in the CSF of participants by ELISA and flow cytometry. Neuronal secretion of sIR was measured after exposure (24 h) to HIV-1 Tat (0.5–250 nM), or specific cytokines. The effects of TNFα and HIV-1 Tat on sIR secretion were also evaluated in the presence of R7050 (TNFα antagonist; 10 nM). Neurons exposed to the CSF of HIV-infected women had higher sIR levels according to the severity of neurocognitive impairment of the participant. Increased CSF sIR levels were associated with the presence and severity of HAND and were positively correlated with CSF HIV-1 Tat levels in HIV-infected women with cognitive impairment. CSF levels of IL-2, IFNγ, and TNFα were significantly increased with HAND. However, only TNFα (5 pg/mL) and HIV-1 Tat (100 nM) induced a significant increase in neuronal sIR secretion after 24 h exposure, an effect that was antagonized when each were combined with R7050. Our data suggests that TNFα and HIV-1 Tat from the CSF of HIV-infected women may regulate the secretion of sIR from neuronal cells and that the effect of HIV-1 Tat on sIR secretion may depend on TNFα receptor activation.
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Affiliation(s)
- Yamil Gerena
- NeuroHIV Research Program, Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Raissa Menéndez-Delmestre
- NeuroHIV Research Program, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Andrea Delgado-Nieves
- NeuroHIV Research Program, Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Joyce Vélez
- NeuroHIV Research Program, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | | | - Javier E Sierra-Pagan
- NeuroHIV Research Program, Department of Pharmacology and Toxicology, School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Lisa Henderson
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Valerie Wojna
- NeuroHIV Research Program, Division of Neurology, Internal Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, United States
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Pereira T, Muguruza J, Mária V, Vilaprinyo E, Sorribas A, Fernandez E, Fernandez-Armenteros JM, Baena JA, Rius F, Betriu A, Solsona F, Alves R. Automatic Methods for Carotid Contrast-Enhanced Ultrasound Imaging Quantification of Adventitial Vasa Vasorum. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2780-2792. [PMID: 30205994 DOI: 10.1016/j.ultrasmedbio.2018.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 06/08/2023]
Abstract
Adventitial vasa vasorum are physiologic microvessels that nourish artery walls. In the presence of cardiovascular risk factors, these microvessels proliferate abnormally. Studies have reported that they are the first stage of atheromatous disease. Contrast-enhanced ultrasound (CEUS) of the carotid allows direct, quantitative and non-invasive visualization of the adventitial vasa vasorum. Hence, the development of computer-assisted methods that speed image analysis and eliminate user subjectivity is important. We developed methods for automatic analyses and quantification of vasa vasorum neovascularization in CEUS and tested these methods in a cohort of 186 individuals, 63 of whom were healthy volunteers. We implemented alternative automatic strategies for using the images to stratify patients according to their risk group and compare the strategies with respect to diagnostic performance. An automatic single-parameter strategy performs less effectively than the corresponding Arcidiacono method based on manual interpretation of the images (68 < area under the receiver operating characteristic curve [AUROC] for the manual Arcidiacono method < 82; 60 < AUROC for the automatic single-parameter strategy < 63). However, by use of additional image parameters, an automatic multiparameter strategy has significantly improved performance with respect to the manual Arcidiacono method (78 < AUROC < 90). The automatic multiparameter strategy is a valuable alternative to the manual Arcidiacono method, improving both diagnostic speed and diagnostic accuracy.
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Affiliation(s)
- Tania Pereira
- Department of Basic Medical Science, University of Lleida, Catalonia, Spain; Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain
| | - Jose Muguruza
- Department of Computer Science, University of Lleida, Catalonia, Spain
| | - Virtu Mária
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova de Lleida (HUAVL), Catalonia, Spain; Vascular and Renal Translational Research Group, IRBLleida, Catalonia, Spain
| | - Ester Vilaprinyo
- Department of Basic Medical Science, University of Lleida, Catalonia, Spain; Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain
| | - Albert Sorribas
- Department of Basic Medical Science, University of Lleida, Catalonia, Spain; Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain
| | - Elvira Fernandez
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova de Lleida (HUAVL), Catalonia, Spain; Vascular and Renal Translational Research Group, IRBLleida, Catalonia, Spain
| | - Jose Manuel Fernandez-Armenteros
- Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain; Servei de Dermatologia, HUAVL and IRBLleida, Catalonia, Spain
| | - Juan Antonio Baena
- Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain; Unitat de Cirurgia Endocrina, Bariàtrica i Metabolica, HUAVL and IRBLleida, Catalonia, Spain
| | - Ferran Rius
- Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain; Endocrinology and Nutrition Department, HUAVL and IRBLleida, Catalonia, Spain
| | - Angels Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Hospital Universitari Arnau de Vilanova de Lleida (HUAVL), Catalonia, Spain; Vascular and Renal Translational Research Group, IRBLleida, Catalonia, Spain
| | - Francesc Solsona
- Department of Computer Science, University of Lleida, Catalonia, Spain
| | - Rui Alves
- Department of Basic Medical Science, University of Lleida, Catalonia, Spain; Institute for Biomedical Research in Lleida, Dr. Pifarré Foundation (IRBLleida), Catalonia, Spain.
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Pereira T, Betriu A, Alves R. Non-invasive imaging techniques and assessment of carotid vasa vasorum neovascularization: Promises and pitfalls. Trends Cardiovasc Med 2018; 29:71-80. [PMID: 29970286 DOI: 10.1016/j.tcm.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
Carotid adventitia vasa vasorum neovascularization (VVn) is associated with the initial stages of arteriosclerosis and with the formation of unstable plaque. However, techniques to accurately quantify that neovascularization in a standard, fast, non-invasive, and efficient way are still lacking. The development of such techniques holds the promise of enabling wide, inexpensive, and safe screening programs that could stratify patients and help in personalized preventive cardiovascular medicine. In this paper, we review the recent scientific literature pertaining to imaging techniques that could set the stage for the development of standard methods for quantitative assessment of atherosclerotic plaque and carotid VVn. We present and discuss the alternative imaging techniques being used in clinical practice and we review the computational developments that are contributing to speed up image analysis and interpretation. We conclude that one of the greatest upcoming challenges will be the use of machine learning techniques to develop automated methods that assist in the interpretation of images to stratify patients according to their risk.
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Affiliation(s)
- T Pereira
- Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, University of Lleida, Catalonia, Spain.
| | - A Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases, Hospital Universitari Arnau de Vilanova de Lleida, Catalonia, Spain; Vascular and Renal Translational Research Group - IRBLleida, Catalonia, Spain
| | - R Alves
- Institute for Biomedical Research in Lleida Dr. Pifarré Foundation, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, University of Lleida, Catalonia, Spain
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Meneses GC, Cavalcante MG, da Silva Junior GB, Martins AMC, Neto RDJP, Libório AB, De Francesco Daher E. Endothelial Glycocalyx Damage and Renal Dysfunction in HIV Patients Receiving Combined Antiretroviral Therapy. AIDS Res Hum Retroviruses 2017; 33:703-710. [PMID: 28260391 DOI: 10.1089/aid.2016.0284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Widespread use of combined antiretroviral therapy (cART) increased HIV patients' life expectancy, however, favored the development of kidney and cardiovascular diseases. The aim of this study was to investigate endothelial glycocalyx (eGC) damage and its association with renal function in HIV patients receiving cART. This is a cross-sectional study with HIV-infected patients with no renal and cardiovascular disease, recruited in public health centers in Brazil. Clinical and laboratory parameters of HIV patients were compared according to cART use and with a healthy control group. Blood ICAM-1 and syndecan-1 levels were quantified by ELISA kit. Estimated glomerular filtration rate (eGFR) was evaluated. A total of 69 HIV patients were included, with mean age of 33.4 ± 8.9 years, and 77.3% were male. Serum urea, creatinine, and eGFR were similar in all groups. No HIV patient had decreased GFR <60 ml/min. All HIV patients had higher systemic syndecan-1 compared with healthy controls (71.8 ± 25.4 ng/ml vs. 36.5 ± 14.3 ng/ml, p < .001). Syndecan-1 showed a significant positive correlation with serum creatinine (r = 0.437, p = .001), serum urea levels (r = 0.352, p = .006), and a negative correlation with eGFR (r = -0.315, p = .015) in HIV patients. Syndecan-1 remained independently associated with serum creatinine and reduced GFR even after we forced variables related with HIV infection status, tenofovir use, treatment time, dyslipidemia, and others in a multivariate analysis. HIV patients using cART with no clinical renal and cardiovascular disease presented eGC damage and it is associated with clinical markers of kidney dysfunction. Syndecan-1 may be a useful early biomarker to monitoring renal dysfunction in HIV patients in chronic use of cART. Further research is needed to evaluate this applicability.
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Affiliation(s)
- Gdayllon Cavalcante Meneses
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Malena Gadelha Cavalcante
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará. Fortaleza, Brazil
| | | | - Alice Maria Costa Martins
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
- Clinical and Toxicological Analysis Department, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Roberto da Justa Pires Neto
- Public Health Postgraduate Program, Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Alexandre Braga Libório
- Medical Sciences Postgraduate Program, School of Medicine, University of Fortaleza, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Medical Sciences Postgraduate Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará. Fortaleza, Brazil
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Manga P, McCutcheon K, Tsabedze N, Vachiat A, Zachariah D. HIV and Nonischemic Heart Disease. J Am Coll Cardiol 2017; 69:83-91. [PMID: 28057254 DOI: 10.1016/j.jacc.2016.09.977] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV)-associated heart disease encompasses a broad spectrum of diseases. HIV infection may involve the pericardium, myocardium, coronary arteries, pulmonary vasculature, and valves, as well as the systemic vasculature. Access to combination antiretroviral therapy, as well as health resources, has had a significant influence on the prevalence and severity of the effects on each cardiac structure. Investigations over the recent past have improved our understanding of the epidemiology and pathophysiology of HIV-associated cardiovascular disease. This review will focus on our current understanding of pathogenesis and risk factors associated with HIV infection and heart disease, and it will discuss relevant advances in diagnosis and management of these conditions.
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Affiliation(s)
- Pravin Manga
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Keir McCutcheon
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Nqoba Tsabedze
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Don Zachariah
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Lawal I, Sathekge M. F-18 FDG PET/CT imaging of cardiac and vascular inflammation and infection. Br Med Bull 2016; 120:55-74. [PMID: 27613996 DOI: 10.1093/bmb/ldw035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inflammation forms an important core of the aetiopathogenic process involved in many diseases affecting the heart and the blood vessels. These diseases include infections as well as inflammatory non-infectious cardiovascular conditions. The common feature of this is invasion of the heart or blood vessel by inflammatory cells. F-18 2-fluoro 2-deoxy-D glucose (FDG) is an analogue of glucose and like glucose it is taken up by activated inflammatory cells that accumulate at the site of infection. This has formed the basis of the use of F-18 FDG PET/CT in the non-invasive evaluation of human inflammatory diseases. SOURCES OF DATA This review is based on the published academic articles as well as our clinical experience. AREAS OF AGREEMENT F-18 FDG PET/CT is a useful imaging modality in the evaluation of cardiovascular inflammatory disorders. Accumulation and distribution of F-18 FDG at the site of inflammation/infection corresponds to severity of the inflammation/infection and extent of involvement. AREAS OF CONTROVERSY Most studies evaluating utility of F-18 FDG PET/CT in imaging cardiovascular inflammation are small observational studies hence are potentially prone to bias. GROWING POINTS Being a hybrid metabolic and morphologic imaging technique, F-18 FDG PET/CT offers combined advantage of complementary anatomic and metabolic information in disease process. This makes it a useful modality in the diagnosis, determination of extent of disease, prognostication as well as treatment monitoring. AREAS TIMELY FOR DEVELOPING RESEARCH Larger prospective studies are needed to validate the superiority of F-18 FDG PET/CT imaging over conventional anatomic imaging modalities.
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Affiliation(s)
- Ismaheel Lawal
- Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
| | - Mike Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
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Orrapin S, Orrapin S, Arworn S, Reanpang T, Rerkasem K. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4. Case Rep Surg 2016; 2016:8572950. [PMID: 27703834 PMCID: PMC5040799 DOI: 10.1155/2016/8572950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/03/2016] [Indexed: 12/03/2022] Open
Abstract
We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity.
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Affiliation(s)
- Saranat Orrapin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saritphat Orrapin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Supapong Arworn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Termpong Reanpang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; NCD Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Pillay B, Ramdial PK, Naidoo DP, Sartorius B, Singh D. Endovascular Therapy for Large Vessel Vasculopathy in HIV-infected Patients. Eur J Vasc Endovasc Surg 2016; 52:343-51. [PMID: 27436174 DOI: 10.1016/j.ejvs.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/08/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate outcomes after endovascular treatment of patients with aneurysmal or occlusive vasculopathy in HIV-infected patients. METHODS Retrospective analysis of a prospective database of treatment outcomes in patients with HIV related vasculopathies between April 2005 and September 2015. RESULTS Sixty HIV patients presented with post-traumatic pseudoaneurysm formation (n = 7), aneurysmal disease (n = 24) or occlusive disease (n = 29 (48%)). The majority were male (42/60 (70%)), with a mean age of 43.9 years (SD ± 12.6). All seven patients with a post-traumatic pseudoaneurysm were treated by insertion of a covered stent (n = 6) or coiling (n = 1). All were successfully treated at 30 days, but only one patient returned for late surveillance. 23/24 patients who underwent insertion of a stent graft/covered stent for aneurysmal disease returned for 30 day review (one asymptomatic stent graft occlusion). Only 11 patients attended for late surveillance; 9/11 were asymptomatic with patent stent grafts. Late stent occlusion occurred in two (no further action (n = 1), major limb amputation (n = 1). In the 29 patients who underwent endovascular treatment for occlusive disease, 9 (31%) had immediate treatment failure (including 8 amputations (28%)). Of the sixteen who returned for serial review, 8 (50%) suffered further complications including 4 amputations. Overall, 12/29 treated patients (41%) ultimately underwent amputation. CONCLUSIONS In the immediate short term, an 'endovascular first' strategy was associated with good outcomes in HIV patients with aneurysmal disease. By contrast, outcomes were poor in HIV patients with occlusive disease. Whether this relates to the underlying natural history of HIV occlusive vasculopathies remains unclear. One major problem in trying to formulate meaningful management strategies is a generalised reluctance for HIV patients to return for surveillance.
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Affiliation(s)
- B Pillay
- Department of Vascular/Endovascular Surgery, Durban, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| | - P K Ramdial
- Department of Anatomical Pathology, Durban, KwaZulu-Natal, South Africa; School of Laboratory Medicine & Medical Sciences, Durban, KwaZulu-Natal, South Africa; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - D P Naidoo
- Department of Cardiology, Durban, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - B Sartorius
- Department of Public Health, Durban, KwaZulu-Natal, South Africa; School of Nursing and Public Health, Durban, KwaZulu-Natal, South Africa; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - D Singh
- Department of Physics, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
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