In HIV-infected veterans with high HIV viral loads or low CD4 T-cell counts, the prevalence of high pulmonary artery systolic pressure (PASP) was increased compared with uninfected people, according to the results of a recent study published in the American Journal of Respiratory and Critical Care Medicine. Increased PASP was shown to be associated with higher mortality risk.
To determine the epidemiology and prognostic impact of PASP in people living with HIV, study participants included veterans who were referred for echocardiography with PASP estimates from the Veterans Aging Cohort study. A total of 2831 veterans with HIV were matched by age, sex, race/ethnicity and clinical site to 5465 veterans without HIV in this observational cohort study (mean follow-up 3.8 years). The researchers evaluated adjusted mortality by HIV status in participants.
Veterans living with HIV with a viral load >500 cells/mm3 had an increased rate of PASP >40 mm Hg (odds ratio [OR] 1.27; 95% CI, 1.05-1.54) compared with veterans without HIV. In a similar fashion, CD4 T-cell count <200 cells/mm3 in participants living with HIV was associated with an increased prevalence of PASP >40 mm Hg (OR 1.28; 95% CI, 1.02-1.60).
Compared with veterans without HIV infection with PASP <40 mm Hg, veterans living with HIV and with PASP >40 mm Hg were at increased risk for death (adjusted hazard ratio 1.78; 95% CI, 1.57-2.01). According to the researchers, adjusted mortality risk was higher in HIV-infected individuals at all PASP values, even individuals who were currently considered normal.
The study investigators explained that their results indicated that “in HIV-infected people, mortality risk increases with increasing PASP values and is present even at lower values of PASP than previously recognized.” They concluded that “these findings may provide rationale for HIV-specific thresholds for invasive evaluation and inform future recommendations for screening and surveillance of HIV-infected individuals for [pulmonary hypertension].”
Brittain EL, Duncan MS, Chang J, et al. Increased echocardiographic pulmonary pressure in HIV-infected and uninfected individuals in the veterans aging cohort study [published online November 13, 2017]. Am J Respir Crit Care Med. doi: 10.1164/rccm.201708-1555OC