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Risk of Pulmonary Hypertension in HIV Infected Patients - A Retrospective Analysis

F Pyaralli

R Iordanov

G Zablah

T Haque

Ramesh Parmar

Catherine Boulanger

Dushyantha Jayaweera

Barry Hurwitz

Michael Kolber

David De La Zerda

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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1017

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.

Authors (Continued)

Martinez C

Background

The advent of highly active antiretroviral therapy (HAART) has substantially improved the survival of HIV-infected individuals, but this has been accompanied by an increase in the prevalence of cardiovascular disease and their complications, including pulmonary hypertension (PH). While this could be attributed to heightened inflammatory state and higher endothelin levels, data on PH and HIV is limited. This study aims to evaluate the risk of PH in HIV-infected adults in a single center in Miami.

Methods

A retrospective chart review was conducted in patients seen at the University of Miami Adult HIV Clinic. Information on demographics, vital signs, lab results, lifestyle factors, and diagnostic studies were collected. Results from two-dimensional echocardiograms were evaluated for right ventricular systolic pressures (RVSP) and tricuspid regurgitant jet velocity (TRJV). Patients were deemed to have “high probability” of PH if the RVSP was greater than 50 mmHg or if the TRJV was greater than 3.4 m/s. Patients were defined as having “intermediate probability” of PH if the RVSP was greater than 35 mmHg or if the TRJV was greater than 2.8 m/s. Univariate logistic regressions were used to calculate odds ratios, and multivariate linear regression was used to identify predictors of RVSP.

Results

A total of 267 patients with diagnosed HIV were reviewed, of which 44 (16.5%) had two-dimensional echocardiograms. In the patients with echocardiograms, the average age was 55.1 years, and 56.8% were male. The average CD4 count was 594.6 (SD 394), and the average viral load was 8471.7 (SD 28,300). One patient (2.7%) of these patients was found to have high probability of PH, and eight patients (21.6%) were identified as having intermediate probability of PH. Being male (OR 2.44), having a history of smoking (OR 1.64), COPD (OR 4.00), diabetes (OR 3.17), and systolic heart failure (OR 9.33) were associated with an intermediate risk of PH. Patients with undetectable viral load were less likely to be classified as intermediate risk (OR 0.35). None of these variables were statistically significant, likely a result of the limited sample size of this study. Linear regression did not show a statistically significant relationship between these predictors and RVSP.

Conclusions

A number of HIV patients that had echocardiograms have findings suggesting pulmonary hypertension, yet echocardiograms are not performed routinely in this population. Given this finding, providers treating HIV patients should be aware of the increased risk of PH in HIV patients compared to the general population, and should consider targeting questions addressing cardiopulmonary symptoms and, if clinically indicated, perform echocardiograms. Further studies evaluating the current epidemiology and risk factors of PH in HIV patients in the current HAART era are needed.

 

Figure 1: Histogram of Right Ventricular Systolic Pressures Based on 2-D Echo Predictors of Pulmonary Hypertension Risk