From the Journals

Large-vessel vasculitis: More severe in HIV-infected patients

 

Key clinical point: Corticosteroid treatments may reduce severity and avoid some complications of LVV in HIV-infected patients.

Major finding: LVV is significantly more severe in HIV-infected patients and is associated more frequently with men.

Study details: A Pitié-Salpêtrière Hospital retrospective study of 11 HIV-infected patients with LVV, compared with 82 uninfected age-matched patients with LVV.

Disclosures: The authors reported that they had no conflicts of interest.

Source: Ferfar Y et al. J Vasc Surg. 2018. doi. org/10.1016/j.jvs.2017.08.099.


 

FROM THE JOURNAL OF VASCULAR SURGERY

Large-vessel vasculitis (LVV) associated with HIV-infected patients occurs more frequently in men and is significantly more severe, compared with the disease in their noninfected counterparts, according to a retrospective analysis of medical records during 2000-2015.

The study was conducted at Pitié-Salpêtrière Hospital in Paris to investigate the occurrence, characteristics, and treatment outcomes of LVV of patients infected with HIV, reported in the Journal of Vascular Surgery. Yasmina Ferfar, MD, and her colleagues diagnosed LVV using available imaging (computed tomography, positron emission tomography, and magnetic resonance angiography), histology, and Ishikawa or American College of Rheumatology (ACR) criteria of Takayasu arteritis (TA). All 93 patients selected for the study had LVV.

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HIV-infected T cells are shown under high magnification.
Only 11 (12%) of the LVV patients also were infected with HIV as determined by HIV seropositivity results. The mean age of these individuals at LVV diagnosis was 40 years and 55% were women. At the time of LVV diagnosis, the mean CD4 T-lymphocyte count and HIV viral load for 10 of the 11 patients (missing data for 1 patient) was 459.5 cells/mm3 and 9,241 copies, respectively.

Vascular lesions were located in three areas; aorta (n = 7), supra-aortic trunks (7), and in digestive arteries (3). The Ishikawa or ACR criteria for TA diagnosis were met by 7 of the 11 (64%) patients.

Highly active antiretroviral therapy was prescribed for six patients at the time of vasculitis diagnosis and for four after diagnosis; HAART was delayed for the remaining patient whose HIV infection was under control.

Steroids, immunosuppressive, statins, and antiplatelet agents were provided in custom combinations to nine patients. Open surgical or endovascular repair was performed on 8 (73%) of the 11 patients with a mean follow-up at 95 months. As recorded at the last follow-up, 6 of the 11 patients had obtained stabilization of the vasculitis, improvement of vascular lesions had occurred in 4 of the 11 patients, and 1 patient had died from complications related to vascular surgery.

An age-matched control test comparison was performed between HIV-infected patients with large-vessel vasculitis and the HIV-negative patients with Takayasu arteritis that were identified in this study. The 82 patients in the LVV HIV-negative group had a median age of 42 years and 72 (88%) were women. Inflammatory syndrome was reported for 30 patients. Glucocorticosteroid treatments were given to 70 patients and immunosuppressive treatments were given to 57 patients.

Comparing LVV between the HIV-infected and their HIV-negative counterparts showed that vascular disease was significantly more severe for HIV-infected patients, according to the Ishikawa score (P = .017) and there was significantly greater use of vascular procedures (P = .047). LVV in association with HIV-infection also occurred more frequently with men (P = .014).

Dr. Ferfar and colleagues suggested that “HIV infection might be an accelerant for vasculitis,” based upon the increased severity of the disease they noted. They also indicated that glucocorticosteroids and immunosuppressive treatments were less often prescribed in HIV-positive patients (P = .001).

The effectiveness of steroids and immunosuppressant drugs seen with 7 of the 11 HIV-positive patients that met the Ishikawa or ACR criteria of TA suggests an overlap between HIV-associated LVV and TA, according to the researchers. Therefore, “HIV-infected patients with LVV should be treated with corticosteroids to avoid complications. Studies with a greater number of HIV-infected patients with LVV are required to confirm this hypothesis”.

The authors reported that they had no conflicts of interest.

SOURCE: Ferfar Y. et al. J Vasc Surg. 2018 Dec 11. doi. org/10.1016/j.jvs.2017.08.099.

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