Reversibility of pulmonary arterial hypertension in HIV/HHV8-associated Castleman's disease.
The present study describes a case of pulmonary arterial hypertension (PAH) associated with multicentric Castleman's disease in a patient infected with HIV type 1 and human herpes virus 8. Therapy included highly active antiretroviral therapy, warfarin, diuretics, continuous i.v. epoprostenol and 12-monthly pulses of cyclophosphamide. The patient's condition improved dramatically with complete reversibility of PAH, allowing weaning of continuous i.v. epoprostenol therapy. After 5 yrs, both Castleman's disease and PAH have not relapsed. This supports the hypothesis that control of inflammation and retroviral replication may be of interest in the context of PAH, complicating the course of an inflammatory condition associated with viral infection. In conclusion, further studies should help in characterising the best candidates for anti-inflammatory treatment in the setting of pulmonary arterial hypertension.
Montani
D
D
Centre des Maladies Vasculaires Pulmonaires, UPRES EA 2705, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Clamart, France.
Achouh
L
L
Marcelin
A G
AG
Viard
J-P
JP
Hermine
O
O
Canioni
D
D
Sitbon
O
O
Simonneau
G
G
Humbert
M
M
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005871:Castleman Disease / Q000150:complications / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use*; D011464:Epoprostenol / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D044966:Anti-Retroviral Agents; D004232:Diuretics; D014859:Warfarin; D003520:Cyclophosphamide; D011464:Epoprostenol