HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study.

Abstract

To assess the clinical and echocardiographic time course, prognosis, and possible etiology of HIV-associated primary pulmonary hypertension (PPH), we prospectively followed all 19 patients in whom PPH was diagnosed in our centers. Women (12 cases) and injecting drug use (16 cases) predominated; the median CD4 lymphocytes count was 83/microliter (range, 1 to 740). Matched control subjects without PPH were identified within the Swiss HIV Cohort Study. Frozen serum samples of both groups were then reanalyzed for autoimmune parameters, neopterin, beta-2-microglobulin, and thyroid-stimulating hormone. The median follow up of the patients was 1.3 yr. Follow-up Doppler echocardiography was available in 13 patients. The RVSP-RAP pressure gradient decreased by 3.2 mm Hg for those six patients who received antiretroviral treatment but increased by 19.0 mm Hg for untreated patients (p = 0.026). PPH was the cause of eight of 17 deaths. The probability of surviving was significantly decreased in patients with PPH in comparison with the control subjects; the median survival was 1.3 versus 2.6 yr (p < 0.05). Patients with PPH had significantly higher anticardiolipin IgM, anti SS-B, and neopterin, but all other laboratory values did not differ between cases and control subjects. In conclusion, HIV-associated PPH contributed significantly to mortality. Antiretroviral treatment may exert a beneficial effect on the pressure gradient. A possible role of an autoimmune phenomenon in the pathogenesis could not be substantiated.

Pulmonary arterial remodeling induced by a Th2 immune response

“…The increased incidence of PAH in autoimmune diseases ( 8 -10 ), chronic obstructive pulmonary disease ( 27,28 ), hypersensitivity pneumonitis ( 29 ), and infectious disease ( 30,31 ) has suggested that chronic infl ammation provides signals that cause pulmonary arterial remodeling. Infl ammation is also associated with pulmonary arterial muscularization in experimental animals, e.g., rats exposed to monocrotaline ( 32,33 ), transgenic mice that overexpress S100A4/Mts1 (a tumorassociated protein) in the lungs ( 34 ), animals exposed to chronic , and (E) corresponding arterial remodeling scores.…”

Risk of Echocardiographic Pulmonary Hypertension in Individuals with Human Immunodeficiency Virus–Hepatitis C Virus Coinfection

“…dysfunction among coinfected patients without a clinical history of liver disease (3)(4)(5). Although many patients had histories of IDU, this did not appear to be a risk factor for PH or right heart abnormalities, nor were additional markers of HIV-HCV activity.…”

“…A variety of systemic illnesses have been associated with PH, including human immunodeficiency virus (HIV) infection (1,2). Over the past two decades, multiple studies have estimated the prevalence of PH in patients with HIV to be approximately 0.5% (3)(4)(5). Although rare, PH complicating HIV infection has not decreased appreciably with available antiretroviral therapy (ART), and the mechanistic link between PH and HIV has not been clearly established (4).…”

“…We hypothesized that the prevalence of PH or RV dysfunction by echocardiogram would be higher in individuals with HIV-HCV coinfection than the reported prevalence of PH in HIV-infected persons alone and that IFN-based treatment for HCV would be a significant risk factor for PH (1)(2)(3)(4)(5).…”

HIV-Associated Lung Infections and Complications in the Era of Combination Antiretroviral Therapy

“…Prevalence is estimated at approximately 1 case per 200 (0.5%) among HIV-infected persons, compared with 1 to 2 cases per million in the non-HIV-infected population (39). Advancing age, a high prevalence of cigarette smoking, and an independent risk from HIV infection all likely contribute, particularly to increases in COPD and lung cancer.…”