HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study.
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.
Opravil
M
M
Department of Medicine, University Hospitals of Zurich, Switzerland.
Pechère
M
M
Speich
R
R
Joller-Jemelka
H I
HI
Jenni
R
R
Russi
E W
EW
Hirschel
B
B
Lüthy
R
R
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D017153:Antibodies, Anticardiolipin / Q000032:analysis; D016022:Case-Control Studies; D016049:Didanosine / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000276:immunology / Q000401:mortality; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D017153:Antibodies, Anticardiolipin; D007075:Immunoglobulin M; D015215:Zidovudine; D016049:Didanosine