Renard Sébastien, Borentain Patrick, Salaun Erwan, Benhaourech Sanaa, Maille Baptiste, Darque Albert, Bregigeon Sylvie, Colson Philippe, Laugier Delphine, Gaubert Martine Reynaud, Habib Gilbert
Department of Cardiology, PAH Regional Expert Center, Hôpital de la Timone, Marseille, France.
Department of Hepato-Gastroenterology, Hôpital de la Timone, Marseille, France.
Chest. 2016 Mar;149(3):e69-73. doi: 10.1016/j.chest.2015.09.018.
Development of direct-acting antiviral agents against hepatitis C virus (HCV) has changed the management of chronic HCV infection. We report three cases of newly diagnosed or exacerbated pulmonary arterial hypertension (PAH) in patients treated with sofosbuvir. All patients had PAH-associated comorbidities (HIV coinfection in two, portal hypertension in one) and one was already being treated for PAH. At admission, all patients presented with syncope, World Health Organization functional class IV, right-sided heart failure, and extremely severe hemodynamic parameters. After specific PAH therapy, the clinical and hemodynamic properties for all patients were improved. Severity and acuteness of PAH, as well as chronology, could suggest a causal link between HCV treatment and PAH onset. We hypothesize that suppression of HCV replication promotes a decrease in vasodilatory inflammatory mediators leading to worsening of underlying PAH. The current report suggests that sofosbuvir-based therapy may be associated with severe PAH.
抗丙型肝炎病毒（HCV）直接作用抗病毒药物的研发改变了慢性HCV感染的治疗方式。我们报告了3例接受索磷布韦治疗的患者新诊断或病情加重的肺动脉高压（PAH）病例。所有患者均有PAH相关的合并症（2例合并HIV感染，1例合并门静脉高压），其中1例已在接受PAH治疗。入院时，所有患者均出现晕厥、世界卫生组织功能分级为IV级、右心衰竭以及极其严重的血流动力学参数。经过特异性PAH治疗后，所有患者的临床和血流动力学特性均得到改善。PAH的严重程度和急性程度以及时间顺序可能提示HCV治疗与PAH发病之间存在因果关系。我们推测，HCV复制的抑制会促使血管舒张性炎症介质减少，从而导致潜在PAH病情恶化。本报告提示，基于索磷布韦的治疗可能与严重PAH有关。
