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Abstract and Introduction
Abstract
Objectives While idiopathic pulmonary arterial hypertension (PAH) is a rare disease, it is seen more frequently in patients with HIV infection. The aim of this study was to evaluate the prevalence of pulmonary hypertension (PH) in patients with HIV infection by echocardiographic screening.
Methods Echocardiography and N-terminal of the prohormone brain natriuretic peptide measurement were used to examine the prevalence of PH prospectively in HIV-positive patients (n = 374) during routine follow-up visits for HIV disease.
Results In echocardiographic screening, PH was detected in a total of 23 of 374 HIV-infected patients (6.1%). Of these, three patients (13%) presented with symptoms of dyspnoea and fatigue, and diagnosis of PAH was confirmed by right heart catheterization. Patients with systolic pulmonary artery pressure (sPAP) > 30 mmHg were more likely to be female, to have a history of injecting drug use and to originate from high-prevalence countries (HPCs).
Conclusions Echocardiographic screening detected PH in a substantial proportion of HIV-positive patients. Female gender, a history of injecting drug use and HPC origin were associated with a higher prevalence of HIV-associated PH. The relevance and long-term outcome of these findings need to be validated in follow-up studies, which are ongoing.
Introduction
As a result of the effectiveness of antiretroviral therapy (ART), HIV infection has become a chronic illness and, consequently, the HIV-infected population is aging. Thus, other major public health problems, such as cardiovascular complications, are increasingly recognized in HIV-positive individuals. Long-term exposure to HIV, ongoing systemic inflammation and ART-associated side effects may affect the progression of cardiovascular diseases.
Before the introduction of effective ART, the prevalence of HIV-associated pulmonary arterial hypertension (PAH) was underestimated, as opportunistic infections were limiting the life expectancy of HIV-infected patients. With the advent of effective ART, studies have identified a higher prevalence of PAH in HIV-infected patients compared with the general population. Since its first description in 1987, the association between HIV infection and PAH has been well established. Pulmonary hypertension (PH) is a haemodynamic state seen in different clinical conditions and characterized by an increase in pulmonary arterial pressure (PAP) (mean PAP > 25 mmHg). PAH is defined by the additional criterion of pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg and exclusion of other causes of PH. The most recent classification of PH includes five main groups, with HIV-associated PAH classified as belonging to group 1. Diagnosis of PAH is often delayed, as the most common symptoms, such as progressive dyspnoea, peripheral oedema, nonproductive cough, fatigue, syncope and atypical chest pain, are unspecific. While echocardiography may be a useful tool with which to detect HIV-related cardiovascular complications, diagnosis of PAH must be confirmed by right heart catheterization. The prognosis of PAH is poor and depends on an early diagnosis and initiation of specific treatment. However, echocardiography is currently not considered part of routine clinical assessment in HIV-infected patients.
In this prospective study, we sought to determine the prevalence and characteristics of PH by echocardiography in a large cohort of well-characterized German HIV-positive patients.
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