HIV-related pulmonary arterial hypertension: clinical presentation and management.
Pulmonary arterial hypertension (PAH) is a progressive albeit rare long-term complication of HIV infection, which has gained importance following the improved survival of HIV-infected patients with the use of HAART. The clinical and pathological findings in PAH associated with HIV infection (HIV-PAH) share many features with the idiopathic form of the disease. HIV-PAH is associated with a particularly poor prognosis and decreased survival compared with HIV-infected patients without this complication, and patients with HIV-PAH tend to die from the effects of PAH rather than as a result of their HIV infection. Prompt diagnosis and effective treatment of PAH in HIV-infected patients is therefore essential. There are currently only limited data regarding the efficacy of PAH therapies in HIV-PAH. Treatment with epoprostenol has been reported to provide benefit in some cases, but is associated with a range of problems linked to the need for continuous intravenous infusion. The dual endothelin receptor antagonist bosentan has proved to be effective in HIV-PAH without affecting the control of HIV infection, and has the benefit of oral administration. Other PAH therapies including prostacyclin analogs, phosphodiesterase type 5 inhibitors and selective endothelin receptor antagonists have yet to be trialed in this setting. Taking into account currently available data and clinical experience, a treatment algorithm for HIV-PAH based on that defined in treatment guidelines for other forms of PAH is suggested.
National Reference Center for Pulmonary Hypertension, Hôpital Antoine Béclère, Clamart, France. olivier.sitbon@abc.ap-hop-paris.fr
Olivier
O
Sitbon
D000959:Antihypertensive Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000077300:Bosentan; D018791:CD4 Lymphocyte Count; D011464:Epoprostenol / Q000031:analogs & derivatives / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011651:Pulmonary Artery / Q000187:drug effects* / Q000502:physiology; D011652:Pulmonary Circulation / Q000187:drug effects; D017466:Receptors, Endothelin / Q000627:therapeutic use*; D012720:Severity of Illness Index; D015819:Substance Abuse, Intravenous / Q000150:complications; D013449:Sulfonamides / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D017466:Receptors, Endothelin; D013449:Sulfonamides; D011464:Epoprostenol; D000077300:Bosentan