Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension.
Bosentan has proven 4-month efficacy in patients with HIV-associated pulmonary arterial hypertension (PAH-HIV). Herein, the long-term outcome of unselected PAH-HIV patients treated with first-line bosentan is described. Data for 59 consecutive World Health Organization (WHO) functional class II-IV PAH-HIV patients treated with first-line bosentan between May 2002 and July 2007 were analysed. HIV status, 6-min walk distance and haemodynamics were assessed at baseline, after 4 months and every 6-12 months thereafter. After 4 months, 6-min walk distance increased from 358+/-98 to 435+/-89 m and pulmonary vascular resistance decreased from 737+/-328 to 476+/-302 dyn x s x cm(-5). At the final evaluation (29+/-15 months), 6-min walk distance remained stable and pulmonary vascular resistance decreased further to 444+/-356 dyn x s x cm(-5). Haemodynamics normalised in 10 patients. At their last evaluation, these 10 patients were in WHO functional class I, with a 6-min walk distance of 532+/-52 m. Overall survival estimates were 93, 86 and 66% at 1, 2 and 3 yrs, respectively. Bosentan was safe when combined with highly active antiretroviral therapy, with no negative impact on HIV infection control. The present data confirm the long-term benefits of bosentan therapy in HIV-associated pulmonary arterial hypertension patients with improvements in symptoms, 6-min walk distance and haemodynamics, and with favourable overall survival.
Degano
B
B
Department of Respiratory and Intensive Care Medicine, Université Paris-Sud 11, National Reference Centre for Pulmonary Arterial Hypertension, Institut Paris-Sud Cytokines, Hôpital Antoine Béclère, Clamart, France.
Yaïci
A
A
Le Pavec
J
J
Savale
L
L
Jaïs
X
X
Camara
B
B
Humbert
M
M
Simonneau
G
G
Sitbon
O
O
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D000077300:Bosentan; D015331:Cohort Studies; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D017079:Exercise Tolerance; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013449:Sulfonamides / Q000008:administration & dosage*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan