Léautez S, Boutoille D, Renard B, Esnault J L, Raffi F
Médecine Interne B, Maladies Infectieuses, CHU Hôtel Dieu, 44093 Nantes, France.
Rev Mal Respir. 2001 Sep;18(4 Pt 1):432-5.
Pulmonary hypertension (PH) appears to be more frequent and more rapidly progressive in HIV+ patients than in the general population. We describe 2 cases of PH in HIV+ patients disclosed by right-side heart failure. The patients were ex-intravenous drug users. On had AIDS and the other was asymptomatic. Both patients had cured hepatitis B and chronic hepatitis C and both died 10 and 11 months after PH diagnosis. Pulmonary hypertension is a likely diagnosis in HIV+ patients with unexplained dyspnea. For primary PH patients, HIV+ serology should be performed. There is probably an indirect mechanism linking PH and HIV. The role of associated chronic hepatitis C is unknown. Treatment of PH is symptomatic using diuretics, calcium-channel inhibitors, and anticoagulation, but with no real efficacy in terms of prognosis. Antiretroviral therapy is recommended. In the future treatment with epoprostenol may perhaps provide improvement in the prognosis of PH in HIV+ patients.
肺动脉高压（PH）在HIV阳性患者中似乎比在普通人群中更常见且进展更快。我们描述了2例因右心衰竭而被发现的HIV阳性患者的PH病例。这两名患者均为既往静脉吸毒者。一名患有艾滋病，另一名无症状。两名患者的乙型肝炎均已治愈，丙型肝炎为慢性，两人均在PH诊断后10个月和11个月死亡。对于原因不明的呼吸困难的HIV阳性患者，肺动脉高压很可能是诊断结果。对于原发性PH患者，应进行HIV阳性血清学检测。PH与HIV之间可能存在间接机制。相关慢性丙型肝炎的作用尚不清楚。PH的治疗采用利尿剂、钙通道抑制剂和抗凝进行对症治疗，但对预后没有实际疗效。建议进行抗逆转录病毒治疗。未来，依前列醇治疗可能会改善HIV阳性患者PH的预后。
