HIV-related pulmonary hypertension : Analytic review of 131 cases

• Published in: Chest Vol. 118; no. 4; pp. 1133 - 1141
• Main Authors: MEHTA, Nirav J, KHAN, Ijaz A, MEHTA, Rajal N, SEPKOWITZ, Douglas A
• Format: Journal Article
• Language: English
• Published: Northbrook, IL American College of Chest Physicians 01.10.2000; Elsevier B.V
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Anti-HIV Agents - therapeutic use; Biological and medical sciences; Biopsy; Child; Child, Preschool; Complications and side effects; Drug therapy; Echocardiography; Electrocardiography; Fatal Outcome; Female; Heart; HIV; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - physiopathology; Human immunodeficiency virus; Human viral diseases; Humans; Hyperplasia; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Pulmonary arteries; Pulmonary hypertension; Pulmonary Wedge Pressure; Risk factors; Ultrasonic imaging; Vascular Resistance; Vasodilator Agents - therapeutic use; Veins & arteries; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Pathophysiology; Respiratory disease; Retroviridae; Cardiovascular disease; AIDS; Immune deficiency; Lentivirus; Pulmonary hypertension; Infection; Virus; Case study; Concomitant disease; Viral disease; Risk factor; Human immunodeficiency virus; Bibliographic review
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.118.4.1133

To report two new cases of HIV-related pulmonary hypertension and to review and analyze the existing reports on the subject. Two new cases of HIV-related pulmonary hypertension are described, and the cases, case series, and related articles on the subject in all languages were identified through a comprehensive MEDLINE search. Among the 131 reviewed cases, 54% were male, and the age range was 2 to 56 years (mean, 33 years). The interval between the diagnosis of HIV disease and the diagnosis of pulmonary hypertension was 33 months. In 82% of cases, pulmonary hypertension was related solely to HIV infection. Presenting symptoms were progressive shortness of breath (85%), pedal edema (30%), nonproductive cough (19%), fatigue (13%), syncope or near-syncope (12%), and chest pain (7%). The mean (+/- SD) pulmonary arterial systolic BP was 67 +/- 18 mm Hg (n = 116), and diastolic BP was 40+/-11 mm Hg (n = 39). Pulmonary vascular resistance was 983+/-420 dyne. s. cm(-5) (n = 29). Chest radiographs demonstrated cardiomegaly (72%) and pulmonary artery prominence (71%). Right ventricular hypertrophy was the most common electrocardiographic finding (67%). Dilatation of the right heart chambers was the most common echocardiographic finding (98%). Plexogenic pulmonary arteriopathy was the most common histopathology (78%). Pulmonary function tests demonstrated mild restrictive patterns with variably reduced diffusing capacities. The responses to vasodilator agents and antiretroviral therapy was variable. Sixty-six patients died during a median follow-up period of 8 months. The median length of time from diagnosis to death was 6 months. HIV infection is an independent risk factor for the development of pulmonary hypertension. The appearance of unexplained cardiopulmonary symptoms in HIV-infected individuals should suggest pulmonary hypertension.