title: [Pulmonary arterial hypertension related to HIV: is inflammation related to IL-6 the cornerstone?].
abstract: Vascular diseases have become the leading cause of mortality in the population treated for HIV infection. Pulmonary arterial hypertension (PAH) related to HIV (PAH-HIV), the fourth cause of PAH in France, has the same histological pattern as other PAH from the group 1 of Dana Point classification. But, conversely to idiopathic PAH in the general population, PAH-HIV is particular by its high frequency in HIV-infected population. This raises the question for the role of inflammation in the PAH-HIV pathophysiology. Its constant occurrence over the decades, despite introduction of combination antiretroviral therapy (CAT), does not preclude the hypothesis of an involvement of inflammation in the genesis of PAH-HIV. Indeed, it is well known that normalization of CD4+ by the CAT does not mean no inflammation. Especially, it persists an increased and continuous production of IL-6, a main cytokine in the genesis of PAH lesions. This inflammation mainly involves the endothelin-1 pathway, which has an action on endothelium and macrophages, leading to high production of IL-6. Moreover, plasmatic level of IL-6 has a prognostic value in PAH-HIV, independently from conventional (functional or hemodynamic) parameters. The use of endothelin receptor antagonist permits major effect on IL-6 production and dramatic effect on PAH in so-called "bosentan responders".
authors.affiliation: Service de Pneumologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France. c.tcherakian@hopital-foch.org
authors.forename: C
authors.initials: C
authors.lastname: Tcherakian
authors.forename: E
authors.initials: E
authors.lastname: Rivaud
authors.forename: E
authors.initials: E
authors.lastname: Catherinot
authors.forename: D
authors.initials: D
authors.lastname: Zucman
authors.forename: A-C
authors.initials: AC
authors.lastname: Metivier
authors.forename: L-J
authors.initials: LJ
authors.lastname: Couderc
mesh_terms: D065627:Familial Primary Pulmonary Hypertension; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology*; D007249:Inflammation / Q000209:etiology* / Q000276:immunology*; D015850:Interleukin-6 / Q000502:physiology*
chemical_list: D015850:Interleukin-6