title: Large vessel adventitial vasculitis characterizes patients with critical lower limb ischemia with as compared to without human immunodeficiency virus infection.
abstract: OBJECTIVE
  Whether a human immunodeficiency virus (HIV)-associated vasculitis in-part accounts for occlusive large artery disease remains uncertain. We aimed to identify the histopathological features that characterize large vessel changes in HIV sero-positive as compared to sero-negative patients with critical lower limb ischemia (CLI).
  
  
  METHODS
  Femoral arteries obtained from 10 HIV positive and 10 HIV negative black African male patients admitted to a single vascular unit with CLI requiring above knee amputation were subjected to histopathological assessment. None of the HIV positive patients were receiving antiretroviral therapy.
  
  
  RESULTS
  As compared to HIV negative patients with CLI, HIV positive patients were younger (p<0.01) and had a lower prevalence of hypertension (10 vs 90%, p<0.005) and diabetes mellitus (0 vs 50%, p<0.05), but a similar proportion of patients previously or currently smoked (80 vs 60%). 90% of HIV positive patients, but no HIV negative patient had evidence of adventitial leukocytoclastic vasculitis of the vasa vasorum (p<0.0001). In addition, 70% of HIV positive, but no HIV negative patient had evidence of adventitial slit-like vessels. Whilst T-lymphocytes were noted in the adventitia in 80% of HIV positive patients, T-lymphocytes were noted only in the intima in HIV negative patients. The presence of femoral artery calcified multilayered fibro-atheroma was noted in 40% of HIV positive and 90% of HIV negative patients with CLI.
  
  
  CONCLUSIONS
  An adventitial vasculitis which characterizes large artery changes in CLI in HIV-infected as compared to non-infected patients, may contribute toward HIV-associated occlusive large artery disease.
authors.affiliation: Department of Surgery, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: Brand
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Woodiwiss
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Frederic
authors.initials: F
authors.lastname: Michel
authors.affiliation: Gritzman and Thatcher Inc., Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Simon
authors.initials: S
authors.lastname: Nayler
authors.affiliation: Department of Surgery, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Veller
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Norton
mesh_terms: D000328:Adult; D063194:Adventitia / Q000473:pathology*; D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D015497:HIV-1; D006801:Humans; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D014651:Vasa Vasorum / Q000473:pathology; D014657:Vasculitis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology