Published online Jun 26, 2014. doi: 10.4330/wjc.v6.i6.495
Revised: February 21, 2014
Accepted: May 8, 2014
Published online: June 26, 2014
Processing time: 194 Days and 5 Hours
AIM: To present 18 new cases of human immunodeficiency virus (HIV)-related pulmonary arterial hypertension (PAH) with presenting features, treatment options and follow-up data.
METHODS: This is a single-centre, retrospective, observational study that used prospectively collected data, conducted during a 14-year period on HIV-related PAH patients who were referred to a pulmonary hypertension unit. All patients infected with HIV were consecutively admitted for an initial evaluation of PAH during the study period and included in our study. Right heart catheterisation was used for the diagnosis of PAH. Specific PAH treatment was started according to the physician’s judgment and the recommendations for idiopathic PAH. The data collected included demographic characteristics, parameters related to both HIV infection and PAH and disease follow-up.
RESULTS: Eighteen patients were included. Intravenous drug use was the major risk factor for HIV infection. Risk factors for PAH, other than HIV infection, were present in 55.5% patients. The elapsed time between HIV infection and PAH diagnoses was 12.2 ± 6.9 years. At PAH diagnosis, 94.1% patients had a CD4 cell count > 200 cells/μL. Highly active antiretroviral therapy (present in 47.1% patients) was associated with an accelerated onset of PAH. Survival rates were 93.8%, 92.9% and 85.7% at one, two and three years, respectively. Concerning specific therapy, 33.3% of the patients were started on a prostacyclin analogue, and the rest were on oral drugs, mainly phosphodiesterase-5 inhibitors. During the follow-up period, specific therapy was de-escalated to oral drugs in all of the living patients.
CONCLUSION: The survival rates of HIV-related PAH patients were higher, most likely due to new aggressive specific therapy. The majority of patients were on oral specific therapy and clinically stable. Moreover, sildenafil appears to be a safe therapy for less severe HIV-related PAH.
Core tip: Human immunodeficiency virus (HIV)-related pulmonary arterial hypertension (PAH) is a rare disease, and HIV-infected patients are seldom included in clinical trials. Therefore, case reports are crucial to better understand this disease and its response to specific therapies. In this retrospective, observational study, 18 HIV-related PAH patients were included. Highly active antiretroviral therapy was associated with an accelerated onset of PAH. The survival rates of HIV-related PAH patients were higher, most likely due to new aggressive specific therapy. The majority of patients were on specific oral therapy and were clinically stable. Furthermore, sildenafil appears to be a safe option for less severe disease.