Naeem, Muhammad

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly affecting around 0.4–0.8% of the population, but limited mortality data exist. We characterized trends and disparities in AAOCA-related mortality in the United States from 1999 to 2023. We queried the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research multiple-cause-of-death database for AAOCA-related deaths among all age groups. Age-adjusted mortality rates (AAMR) per 1,000,000 population with 95% confidence interval, stratified by year, sex, race, regions, and urbanization status, were abstracted. Annual percent changes were computed by Joinpoint regression. From 1999 to 2023, there were 6665 AAOCA-related deaths. Overall AAMR fell insignificantly from 1.1 in 1999 to 0.9 by 2001, rose to 1.1 in 2008, declined significantly to 0.5 by 2020, and then increased to 0.8 by 2023. Male AAMRs exceeded females (1999: 1.3 vs 0.9; 2023: 1.2 vs 0.4). Racially, from 1999–2020 to 2021–2023, non-Hispanic (NH) Blacks exhibited the highest AAMR (1.8 vs 1.5), trailed by NH Whites (0.8 vs 0.6) and Hispanics (0.5 vs 0.6). Regionally, AAMRs from 1999 to 2020 were 0.9 in the Northeast, Midwest, and South, and 0.8 in the West. Moreover, both urban and rural AAMRs were 0.9. Among age groups, <44 years mortality declined, with the steepest drop in 15–44 years, while mortality for >45 years plateaued. Although AAOCA mortality declined overall, especially in children and young adults, it remains high among men, NH Blacks, and Midwest residents. Its recent rebound underscores the need for early detection, risk stratification, and surveillance for timely interventions.

Antiretroviral therapy has transformed treatment of HIV infection from a fatal disease into a chronic condition, yet opportunistic infections remain prevalent in patients with declining CD4 cell counts, requiring a pattern-based radiologic approach and vigilant clinical assessment to differentiate infections, malignancies, and immune reconstitution inflammatory syndrome.