Role of HIV and human herpesvirus-8 infection in pulmonary arterial hypertension.
BACKGROUND
Previous work has found a high prevalence of pulmonary arterial hypertension in HIV-infected persons, but establishment of a causal relationship has been limited by the lack of well characterized contemporaneous HIV-uninfected comparator groups. Among HIV-uninfected persons, human herpesvirus-8 (HHV-8) has also been linked to pulmonary arterial hypertension (PAH), but whether this relationship occurs among HIV-infected persons - who have among the highest prevalence of HHV-8 infection - has not been examined.


RESULTS
We echocardiographically calculated pulmonary artery systolic pressure and measured HHV-8 antibodies in HIV-infected and HIV-uninfected adults. Among the 196 HIV-infected participants, the median pulmonary artery systolic pressure (PASP) was 27.5 mmHg and 35.2% had PASP greater than 30 mmHg. This compared to a median of 22 mmHg among 52 HIV-uninfected participants in whom 7.7% had a PASP greater than 30 mmHg (P < 0.001). After adjustment for injecting drug and stimulant use, smoking, age, and gender, HIV-infected participants had 5.1 mmHg higher mean PASP and seven fold greater odds of having a PASP greater than 30 mmHg (P < 0.001). Although we found no association between HHV-8 and PAH among all HIV-infected participants, a borderline relationship was present when restricting to those without risk factors for PAH.


CONCLUSIONS
HIV-infected persons have a high prevalence of elevated PASP, which is independent of other risk factors for PAH. This suggests a causal role of HIV in PAH and emphasizes the need to understand the natural history of PAH in this setting. A role for HHV-8 infection in PAH remains much less definitive.
Hsue
Priscilla Y
PY
Divisions of Cardiology, San Francisco General Hospital, San Francisco, CA 94110, USA. phsue@medsfgh.ucsf.edu
Deeks
Steven G
SG
Farah
Husam H
HH
Palav
Swapna
S
Ahmed
Samira Y
SY
Schnell
Amanda
A
Ellman
Allison B
AB
Huang
Laurence
L
Dollard
Sheila C
SC
Martin
Jeffrey N
JN
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D015150:Echocardiography, Doppler; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging; D015497:HIV-1 / Q000235:genetics; D006566:Herpesviridae Infections / Q000150:complications* / Q000000981:diagnostic imaging; D019288:Herpesvirus 8, Human / Q000276:immunology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000821:virology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012367:RNA, Viral / Q000097:blood; D012514:Sarcoma, Kaposi / Q000150:complications / Q000000981:diagnostic imaging
D000914:Antibodies, Viral; D012367:RNA, Viral