Olalla Julián, Urdiales Daniel, Pombo Marta, del Arco Alfonso, de la Torre Javier, Prada José Luis
Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España.
Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España.
Med Clin (Barc). 2014 Mar 20;142(6):248-52. doi: 10.1016/j.medcli.2012.12.018. Epub 2013 Mar 13.
Pulmonary arterial hypertension (PAH) is a serious disorder, more prevalent in patients infected with human immunodeficiency virus (HIV). It is not entirely clear what role is played by highly active antiretroviral therapy (HAART) in PAH development or course. Our aim was to describe PAH prevalence in a series of HIV-infected patients and identify possible links with cumulative and current use of different antiretrovirals.
Cross-sectional study of a cohort of HIV-infected patients attending a hospital in southern Spain. Demographic data, data on HIV infection status and on cumulative and recent antiretroviral treatment were recorded. Transthoracic echocardiography was performed in all study participants. PAH was defined as pulmonary artery systolic pressure of 36mmHg or more.
A total of 400 patients participated in the study; 178 presented with tricuspid regurgitation and 22 of these presented with PAH (5.5%). No differences were encountered in age, sex, CD4 lymphocytes, proportion of naive patients or patients with AIDS. No differences were encountered in cumulative use of antiretrovirals. However, recent use of lamivudine was associated with a greater presence of PAH, whereas recent use of tenofovir and emtricitabine was associated with a lower presence of PAH. Logistic regression analysis was performed including the use of lamivudine, emtricitabine and tenofovir. Only recent use of tenofovir was associated with a lower presence of PAH (odds ratio 0.31; 95% confidence interval: 0.17-0.84).
PAH prevalence in our study was similar to others series. Current use of tenofovir may be associated with lower PAH prevalence.
肺动脉高压（PAH）是一种严重疾病，在感染人类免疫缺陷病毒（HIV）的患者中更为常见。高效抗逆转录病毒治疗（HAART）在PAH发生或病程中所起的作用尚不完全清楚。我们的目的是描述一系列HIV感染患者中PAH的患病率，并确定与不同抗逆转录病毒药物的累积使用和当前使用之间可能存在的联系。
对西班牙南部一家医院的一组HIV感染患者进行横断面研究。记录人口统计学数据、HIV感染状况数据以及抗逆转录病毒治疗的累积和近期治疗情况。对所有研究参与者进行经胸超声心动图检查。PAH定义为肺动脉收缩压≥36mmHg。
共有400名患者参与研究；178例出现三尖瓣反流，其中22例出现PAH（5.5%）。在年龄、性别、CD4淋巴细胞、初治患者或艾滋病患者比例方面未发现差异。在抗逆转录病毒药物的累积使用方面未发现差异。然而，近期使用拉米夫定与PAH的发生率较高相关，而近期使用替诺福韦和恩曲他滨与PAH的发生率较低相关。进行了逻辑回归分析，纳入了拉米夫定、恩曲他滨和替诺福韦的使用情况。仅近期使用替诺福韦与PAH的发生率较低相关（比值比0.31；95%置信区间：0.17 - 0.84）。
我们研究中的PAH患病率与其他系列研究相似。当前使用替诺福韦可能与较低的PAH患病率相关。
