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Prevalence of HIV-related Pulmonary Arterial Hypertension in the Current Antiretroviral Therapy Era

¹ Service de Pneumologie et Reanimation, Hôpital Antoine Béclère, Clamart, France; ² Service de Medecine Interne, Hôpital Saint Louis, Paris, France; ³ Service de Medecine Interne, Hôpital Bicêtre, Le Kremlin Bicêtre, France; ⁴ Service des Maladies Infectieuses et Tropicales A, Hôpital Bichat, Paris, France; ⁵ CISIH, Hôtel Dieu, Nantes, France; ⁶ Service de Medecine Interne, Hôpital du Perpétuel Secours, Levallois Perret, France; ⁷ Actelion Pharmaceuticals France, Paris, France; and ⁸ Orgamétrie, Roubaix, France

Correspondence and requests for reprints should be addressed to Olivier Sitbon, M.D., Ph.D., Service de Pneumologie Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart, France. E-mail: olivier.sitbon{at}abc.aphp.fr

Rationale: The prevalence of HIV-associated pulmonary arterial hypertension (PAH) has not been evaluated since introduction of combined, highly active antiretroviral treatments.

Objectives: To establish the current prevalence of PAH in a large HIV-positive population.

Methods: Prospective study conducted in 7,648 consecutive HIV-positive adults in 14 HIV clinics in France. PAH was identified through screening with a predefined algorithm. Patients with dyspnea unexplained by other causes underwent transthoracic Doppler echocardiography. PAH was suspected if peak velocity of tricuspid regurgitation was greater than 2.5 m/second and was confirmed by right heart catheterization.

Measurements and Main Results: PAH was diagnosed if mean pulmonary arterial pressure at rest was 25 mm Hg or greater (with pulmonary capillary wedge pressure 15 mm Hg) or 30 mm Hg or greater on exercise. A total of 739 patients had dyspnea, of which 312 met exclusion criteria and 150 refused to participate. Among the remaining 277, 30 had known PAH and 247 had unexplained dyspnea and underwent echocardiography; PAH was suspected in 18 and confirmed in 5, to give a total of 35 cases. The prevalence was thus 0.46% (95% confidence interval, 0.32–0.64%). All new cases had relatively milder PAH.

Conclusions: The prevalence of HIV-associated PAH is about the same as it was in the early 1990s. Given the current good long-term prognosis of patients with HIV, the severity of PAH in HIV-infected patients, and the absence of predictive factors, careful screening for PAH is warranted for patients with unexplained dyspnea.

Key Words: dyspnea • echocardiography, Doppler • epidemiologic studies • HIV infection • hypertension, pulmonary • prevalence

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject One established risk factor for development of pulmonary arterial hypertension (PAH) is HIV infection, with the main symptom, progressive dyspnea, reported in about 85% of patients. In the early 1990s, when highly active antiretroviral treatments (HAART) were not available, prevalence of HIV-PAH was 0.5% (95% confidence interval, 0.10–0.90%). What This Study Adds to the Field The prevalence of HIV-associated PAH is about the same as it was in the early 1990s. Given the current good long-term prognosis of patients with HIV, the severity of PAH in HIV-infected patients, and the absence of predictive factors, careful screening for PAH is warranted for patients with unexplained dyspnea.

 

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