Exercise-induced pulmonary hypertension in HIV patients: Association with poorer clinical and immunological status.

Abstract

BACKGROUND AND AIM\nExercise-induced pulmonary hypertension (Ex-PH) may represent the earliest sign of pulmonary arterial hypertension (PAH) in human immunodeficiency virus (HIV) patients. We investigated its association with clinical and immunological status, virologic control, and response to antiviral therapy.\n\n\nMETHODS\nIn 32 consecutive HIV patients with either low (n\u202f=\u202f29) or intermediate probability (n\u202f=\u202f3) of PH at rest, we evaluated the association of isolated ExPH with: time to HIV diagnosis; CD4+ T-cell count; clinical progression to acquired immunodeficiency syndrome (AIDS); development of resistance to antiretroviral therapy (ART); HIV RNA levels; time to beginning of ART; current use of protease inhibitors; combination of ART with boosters (ritonavir or cobicistat); immuno-virologic response to ART; and ART discontinuation. Isolated ExPH at stress echocardiography (ESE) was defined as absence of PH at rest and systolic pulmonary arterial pressure (sPAP) >45\u202fmmHg or a >20\u202fmmHg increase during low-intensity exercise cardiac output (<10\u202fL/min).\n\n\nRESULTS\nIn our cohort, 22% (n\u202f=\u202f7) of the enrolled population developed ExPH which was inversely related to CD4+ T-cell count (p\u202f=\u202f0.047), time to HIV diagnosis (p\u202f=\u202f0.014) and time to onset of ART (p\u202f=\u202f0.041). Patients with ExPH had a worse functional class than patients without ExPH (p\u202f<\u202f0.001). ExPH and AIDS showed a trend (p\u202f=\u202f0.093) to a direct relationship. AIDS patients had a higher pulmonary vascular resistance compared to patients without ExPH (p\u202f=\u202f0.020) at rest echocardiography.\n\n\nCONCLUSIONS\nThe presence of isolated ExPH associates with a worse clinical status and poorer immunological control in HIV patients. Assessment of ExPH by ESE may help identify subgroups of HIV patients with a propensity to develop subclinical impairment of pulmonary circulation following poor control of HIV infection.