HIV-related pulmonary hypertension. From pathogenesis to clinical aspects.
HIV-related pulmonary hypertension (HIV-PH) is a cardiovascular complication of HIV infection that has been recognized in the last years with increasing frequency. HIV-related pulmonary hypertension is a clinical disorder which carries a bad prognosis. While a direct HIV infection of the pulmonary vessels in the pathogenesis of this disorder was not demonstrated, currently a multifactorial pathogenesis of this disease could be hypothesized. Echocardiography has been found to be the most useful screening imaging modality for the diagnosis of HIV-PH, with a high predictive negative value and a low positive predictive value. For this reason Doppler echocardiography is not the gold standard in the diagnosis of HIV-PH. The treatment of HIV-PH is complex and controversial. To date, no study determining the agent of choice for the treatment of this disease exists. Different studies have shown variable results in patiens with HIV-PH treated with highly active antiretroviral therapy (HAART) but only HAART seems not to be effective in lowering pulmonary hypertension in these patients, and in some patients, HIV-PH develops in spite of a previous HAART. It seems reasonable in HIV-PH patients that a treatment with oral vasodilator drugs can improve the adherence of a long-lasting and complex antiretroviral therapy.
Pellicelli
Adriano M
AM
Infectious Diseases, San Camillo Forlanini Hospital, Italy. apellicelli@scamilloforlanini.rm.it
D'Ambrosio
Cecilia
C
Vizza
Carmine Dario
CD
Borgia
Maria Clotilde
MC
Tanzi
Piero
P
Pino
Paolo
P
Zachara
Elisabetta
E
Soccorsi
Fabrizio
F
D016207:Cytokines; D004452:Echocardiography; D019332:Endothelin-1; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D011379:Prognosis; D016019:Survival Analysis
D016207:Cytokines; D019332:Endothelin-1