Korean J Med.  2011 Dec;81(6):729-739.

Prevalence and Clinical Characteristics of Pulmonary Arterial Hypertension in Human Immunodeficiency Virus-Infected Patients

• Kim M
• Chang HJ
• Yang YJ
• Hong JY
• Kang MK
• Yang WI
• Shim CY
• Ha JW
• Chung N
• Shin SY
• Han SH
• Choi JY
• Kim JM

Abstract

BACKGROUND/AIMS
Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is a complication of HIV infection. Due to improvements in HIV survival rates following the introduction of highly active antiretroviral therapy, HIV-PAH has become an important cause of HIV-related morbidity. Thus, the objective of this study was to explore the prevalence and characteristics of HIV-PAH.
METHODS
Ninety-two patients were enrolled in the study from March to August 2010. We investigated clinical characteristics and performed echocardiography. HIV-PAH was defined as having a mean pulmonary arterial pressure (mPAP) > or = 25 mmHg based on Mahan's equation, without lung disease or heart disease. The HIV-PAH-possible group was defined as having a tricuspid regurgitation velocity (TRV) of 2.9-3.4 m/s and a pulmonary arterial systolic pressure (PASP) of 37-50 mmHg.
RESULTS
Fifteen patients (16.3%) met the criteria of HIV-PAH based on mPAP. With respect to TRV, six patients met the criteria of the HIV-PAH-possible group. Based on the criteria of mPAP, the duration of HIV infection was not different with or without HIV-PAH. HIV RNA titers and CD4 T cell counts tended to be higher in HIV-PAH patients (8,607 +/- 11 vs. 1,067 +/- 64 copies/mL, p = 0.371; 471 +/- 148 vs. 499 +/- 252 cells/mm3, p = 0.680, respectively). Echocardiographic indices of the right ventricle were significantly deteriorated in the HIV-PAH group as compared with the non-HIV-PAH group (TASPE: 20.52 vs. 23.2, p = 0.001; Tei index: 0.42 vs. 0.39, p = 0.037). In a multivariate regression analysis, HIV activity factors (HIV duration, HIV RNA titer, and CD4 cell count) were not associated with echocardiographic indices of PAH (mPAP, PASP, and pulmonary vascular resistance).
CONCLUSIONS
In this study, the prevalence of HIV-PAH was comparable to that of previous studies.

Keyword

Echocardiography; Human immunodeficiency virus; Pulmonary hypertension

MeSH Terms

Antiretroviral Therapy, Highly Active
Arterial Pressure
Blood Pressure
Cell Count
Cyclophosphamide
Echocardiography
Heart Diseases
Heart Ventricles
HIV
HIV Infections
Humans
Hypertension
Hypertension, Pulmonary
Lung Diseases
Prevalence
RNA
Survival Rate
Tricuspid Valve Insufficiency
Cyclophosphamide
Hypertension, Pulmonary
RNA