Cardiopulmonary function in individuals with HIV infection in the antiretroviral therapy era.
OBJECTIVE
To determine relationship of echocardiographic measures of pulmonary hypertension to lung function and inflammatory biomarkers in HIV-infected individuals.


METHODS
Cross-sectional study of 116 HIV-infected outpatients.


METHODS
Doppler-echocardiography and pulmonary function testing were performed. Induced sputum and plasma cytokines, sputum cell counts and differentials, markers of peripheral T-cell activation, and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured. Univariate and multivariate analyses determined relationship of echocardiographic variables to pulmonary function, inflammation, and NT-proBNP.


RESULTS
Mean estimated pulmonary artery systolic pressure (PASP) was 34.3 mmHg (SD 6.9) and mean tricuspid regurgitant jet velocity (TRV) was 2.5 m/s (SD 0.32). Eighteen participants (15.5%) had PASP of at least 40 mmHg, and nine (7.8%) had TRV of at least 3.0 m/s. Elevated TRV was significantly associated with CD4 cell counts below 200 cells/μl and higher log HIV-RNA levels. Forced expiratory volume in 1 s (FEV(1)) percentage predicted, FEV(1)/forced vital capacity, and diffusing capacity for carbon monoxide (DLco) percentage predicted were significantly lower in those with elevated PASP or TRV. Sputum interleukin-8, peripheral interleukin-8, peripheral interferon-γ levels, and CD8(+) T-cell expression of CD69(+) were associated with increasing PASP and TRV. Log NT-proBNP was significantly higher with increasing PASP and TRV. Left ventricular function was not associated with PASP or TRV.


CONCLUSIONS
Echocardiographic manifestations of pulmonary hypertension are common in HIV and are associated with respiratory symptoms, more advanced HIV disease, airway obstruction, abnormal DLco, and systemic and pulmonary inflammation. Pulmonary hypertension and chronic obstructive pulmonary disease coexist in HIV and may arise secondary to common inflammatory mechanisms.
Department of Medicine, University of Alabama, Birmingham, USA. morrisa@upmc.edu
Alison
A
Morris
Matthew R
MR
Gingo
M Patricia
MP
George
Lorrie
L
Lucht
Cathy
C
Kessinger
Vikas
V
Singh
Maria
M
Hillenbrand
Michelle
M
Busch
Deborah
D
McMahon
Karen A
KA
Norris
Hunter C
HC
Champion
Mark T
MT
Gladwin
Yingze
Y
Zhang
Chad
C
Steele
Frank C
FC
Sciurba
D015415:Biomarkers / Q000378:metabolism; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D005541:Forced Expiratory Volume; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D012367:RNA, Viral; D012129:Respiratory Function Tests; D012307:Risk Factors; D013183:Sputum / Q000737:chemistry; D014797:Vital Capacity
D015415:Biomarkers; D016207:Cytokines; D010446:Peptide Fragments; D012367:RNA, Viral; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain