Background:  Pulmonary arterial hypertension (PAH) occurs more frequently in HIV-infected than in HIV-negative individuals and is associated with a poor prognosis. Recent studies indicated that HAART may beneficially affect the severity of HIV-associated PAH. However, the effect of HAART on the prevalence and clinical symptoms of this devastating condition has not been systematically investigated.

Methods:  In a prospective study, 200 consecutive HIV-infected patients (166 males, 34 females; median age 44 years [21 to 77 years); CD4 200/µL, 0 to 1000/µL, n = 82; CDC C), who were treated with highly active antiretroviral therapy (HAART) for at least 3 months, were screened for PAH by the use of 2D- and Doppler echocardiography. PAH was defined as mean pulmonary arterial pressure (PAP_mean) > 25 mmHg, or systolic right ventricular pressure (PRV_syst) > 30 mmHg at rest.

Result:  PAH was diagnosed in 15 of 200 patients (7.5 %). 1 patient was in WHO class IV (dyspnea at rest), 3 and 3 patients in WHO classes III and II, respectively, and 8 patients were asymptomatic. Signs of pressure overload to the right heart, such as right ventricular dilation (> 25 mm), were observed in 8 of 15 patients (53%), and increased plasma levels of B-type natriuretic peptide, indicating right heart failure, were found in 6 of 15 (40 %) of patients. Plasma levels of B-type natriuretic peptide correlated with the severity of PAH and were normal in individuals without PAH.

Conclusions:  Although the clinical symptoms and signs of right heart failure were rather moderate, the prevalence of HIV-associated PAH is significant even in HAART-treated patients. Hence, HAART alone is not sufficient to prevent PAH in HIV patients, and specific treatment may be required. Since medical treatment options for PAH have improved recently and are thought to improve survival, screening of HIV-infected individuals for PAH seems warranted.

Keywords: Pulmonary hypertension; Echocardiography; HAART