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Prevalence of Pulmonary Arterial Hypertension in HIV Positive Outpatients in the HAART Era
Daniel Sereni*1, O Sitbon2, C Lascoux-Combe1, F Raffi3, G Pialoux4, P Yeni5, V Gressin6, P Clerson7, J F Delfraissy8, and G Simonneau2
1Hosp Saint Louis, Paris, France; 2Hosp A Béclère, Clamart, France; 3Unité de Recherche VIH, Nantes, France; 4Hosp Tenon, Paris, France; 5Hosp Bichat, Paris, France; 6Actelion Pharma, Paris, France; 7Orgamétrie, Roubaix, France; and 8Hosp Bicêtre, Le Kremlin Bicêtre, France
Background: Pulmonary Arterial Hypertension (PAH) is a rare but
severe complication of HIV infection. When early studies in the 90s reported a
prevalence of 0.50% [95% CI: 0.10-0.90%], recent reports are controversial with
regards to impact of HAART. The objective of our study was to assess the
prevalence of PAH in a large population of patients followed for HIV infection
according to current medical management.
Methods: This prospective nationwide study was conducted in 15 HIV
centers in France. Consecutive HIV patients attending the clinic
for their regular follow-up were assessed for dyspnea based on a questionnaire.
Unless another cause was diagnosed, patients with dyspnea (NYHA functional
class ³
2) were screened for PAH according to a pre-defined algorithm based on
transthoracic Doppler echocardiography (TTE): PAH was suspected if the peak
velocity of tricuspid regurgitation was > 2.5 m/s, or, when not measurable,
if the peak velocity of pulmonary regurgitation was > 2.0 m/s (proto
diastolic) or > 1.2 m/s (end diastolic). Right heart catheterization (RHC)
was then warranted: PAH was confirmed if mean pulmonary artery pressure was ³ 25
mmHg at rest with pulmonary capillary wedge pressure < 15 mmHg. Patients
with a known PAH previously diagnosed on RHC were also enrolled but did not
have to undergo any study procedure.
Results: 10,547
patients were seen by the investigational centers during the recruitment period (March 04 to
March 05). Among them, 17 patients had a known PAH, and
249 patients were identified as having dyspnea not explained by another cause
and underwent all study procedures. TTE results suggested PAH in 16 / 249
patients (6%). These 16 patients underwent RHC which confirmed PAH in 5.
Overall, 22 patients out of 10,547 (0.21%; [95% CI: 0.12-0.30%]) presented with
PAH.
Conclusion: The
low estimate for prevalence of PAH in our study was 0.21%, similar to that
previously reported in the 90s. Given the good long term prognosis of HIV
patients in the HAART era and the severity of PAH in HIV infected patients,
screening for PAH according to a precise algorithm is warranted in patients
presenting with dyspnea not explained by another cause.
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