title: A prospective evaluation of pulmonary, systemic and hepatic haemodynamics in HIV-HCV-coinfected patients before and after antiviral therapy with pegylated interferon and ribavirin.
abstract: BACKGROUND
  Patients coinfected with HIV and HCV are at risk for developing portal hypertension (PHT), hyperdynamic circulation and pulmonary arterial hypertension (PAH). Data on the influence of antiviral therapy with pegylated interferon-α (PEG-IFN-α) and ribavirin (RBV) are limited.
  
  
  METHODS
  Haemodynamic parameters, including hepatic venous pressure gradient (HVPG), pulmonary arterial pressure (PAP(mean)), cardiac output (CO) and systemic vascular resistance (SysVR), were prospectively evaluated before and after PEG-IFN-α+RBV therapy in 80 HIV-HCV-coinfected patients.
  
  
  RESULTS
  Baseline evaluation showed a mean HVPG of 4.7 mmHg, CO of 6.15 l/min and PAP(mean) of 14.8 mmHg. PHT was present in 26% of patients, hyperdynamic circulation in 5% and PAH in 4%. Patients with advanced fibrosis (METAVIR stage F3/F4; n=32) had significantly higher CO (P=0.008), lower SysVR (P=0.035), higher PAP(mean) (P=0.018) and higher pulmonary vascular resistance (P=0.022) than patients with stage F0-F2 fibrosis (n=48). Both hyperdynamic circulation and PAH were significantly associated with liver stiffness, fibrosis stage and portal pressure; a non-significant trend was found for CD4(+) T-cell counts and HIV RNA levels. No significant changes in PAP(mean), CO and SysVR were observed after PEG-IFN-α+RBV treatment, although a significant decrease in HVPG was noted in patients with HCV eradication (P=0.013).
  
  
  CONCLUSIONS
  The overall prevalence of hyperdynamic circulation and PAH in HIV-HCV coinfection is low. Advanced fibrosis, increased liver stiffness, elevated portal pressure and probably CD4(+) T-cell count and HIV viraemia represent risk factors for hyperdynamic circulation and PAH. PHT is present in 26% of HIV-HCV-coinfected patients evaluated for antiviral therapy. Successful HCV eradication significantly decreases HVPG.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reiberger
authors.forename: Berit A
authors.initials: BA
authors.lastname: Payer
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sieghart
authors.forename: Florian
authors.initials: F
authors.lastname: Breitenecker
authors.forename: Maximilian C
authors.initials: MC
authors.lastname: Aichelburg
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schmied
authors.forename: Armin
authors.initials: A
authors.lastname: Rieger
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Markus
authors.initials: M
authors.lastname: Peck-Radosavljevic
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002302:Cardiac Output; D060085:Coinfection / Q000097:blood* / Q000188:drug therapy / Q000821:virology; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000821:virology; D006439:Hemodynamics; D016174:Hepacivirus / Q000472:pathogenicity; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000503:physiopathology; D016898:Interferon-alpha / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000503:physiopathology; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012254:Ribavirin / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014766:Viremia / Q000821:virology
chemical_list: D044966:Anti-Retroviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D011092:Polyethylene Glycols; D012254:Ribavirin