1 Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
2 Vanderbilt Translational and Clinical Cardiovascular Research Center, Nashville, Tennessee.
Am J Respir Crit Care Med. 2018 Apr 1;197(7):923-932. doi: 10.1164/rccm.201708-1555OC.
The epidemiology and prognostic impact of increased pulmonary pressure among HIV-infected individuals in the antiretroviral therapy era is not well described.
To examine the prevalence, clinical features, and outcomes of increased echocardiographic pulmonary pressure in HIV-infected and -uninfected individuals.
This study evaluated 8,296 veterans referred for echocardiography with reported pulmonary artery systolic pressure (PASP) estimates from the Veterans Aging Cohort study, an observational cohort of HIV-infected and -uninfected veterans matched by age, sex, race/ethnicity, and clinical site. The primary outcome was adjusted mortality by HIV status.
PASP was reported in 2,831 HIV-infected and 5,465 HIV-uninfected veterans (follow-up [mean ± SD], 3.8 ± 2.6 yr). As compared with uninfected veterans, HIV-infected veterans with HIV viral load greater than 500 copies/ml (odds ratio, 1.27; 95% confidence interval [CI], 1.05-1.54) and those with CD4 cell count less than 200 cells/μl (odds ratio, 1.28; 95% CI, 1.02-1.60) had a higher prevalence of PASP greater than or equal to 40 mm Hg. As compared with uninfected veterans with a PASP less than 40 mm Hg, HIV-infected veterans with a PASP greater than or equal to 40 mm Hg had an increased risk of death (adjusted hazard ratio, 1.78; 95% CI, 1.57-2.01). This risk persisted even among participants without prevalent comorbidities (adjusted hazard ratio, 3.61; 95% CI, 2.17-6.01). The adjusted risk of mortality in HIV-infected veterans was higher at all PASP values than in uninfected veterans, including at values currently considered to be normal.
HIV-infected people with high HIV viral loads or low CD4 cell counts have a higher prevalence of increased PASP than uninfected people. Mortality risk in HIV-infected veterans increases at lower values of PASP than previously recognized and is present even among those without prevalent comorbidities. These findings may inform clinical decision-making regarding screening and surveillance of pulmonary hypertension in HIV-infected individuals.
在抗逆转录病毒治疗时代，艾滋病毒感染者中肺动脉压升高的流行病学和预后影响尚不清楚。
研究艾滋病毒感染者和未感染者中超声心动图肺动脉压升高的患病率、临床特征和结局。
这项研究评估了 Veterans Aging Cohort 研究中的 8296 名接受超声心动图检查的退伍军人，该研究是一个观察性的艾滋病毒感染者和未感染者队列，按年龄、性别、种族/民族和临床地点与 HIV 感染者和未感染者相匹配。主要结局是按 HIV 状况调整后的死亡率。
在 2831 名 HIV 感染者和 5465 名 HIV 未感染者中报告了肺动脉收缩压（PASP）（随访[平均值±标准差]，3.8±2.6 年）。与未感染的退伍军人相比，HIV 病毒载量大于 500 拷贝/ml 的 HIV 感染者（比值比，1.27；95%置信区间[CI]，1.05-1.54）和 CD4 细胞计数小于 200 个/μl 的 HIV 感染者（比值比，1.28；95%CI，1.02-1.60）的 PASP 大于或等于 40mmHg 的患病率更高。与 PASP 小于 40mmHg 的未感染退伍军人相比，PASP 大于或等于 40mmHg 的 HIV 感染者死亡风险增加（调整后的危险比，1.78；95%CI，1.57-2.01）。即使在没有常见合并症的参与者中，这种风险仍然存在（调整后的危险比，3.61；95%CI，2.17-6.01）。在所有 PASP 值中，HIV 感染者的调整死亡率均高于未感染者，包括目前认为正常的 PASP 值。
高 HIV 病毒载量或低 CD4 细胞计数的 HIV 感染者比未感染者有更高的 PASP 升高患病率。与以前认为的相比，HIV 感染者的 PASP 值越低，死亡率风险越高，即使在没有常见合并症的患者中也是如此。这些发现可能为 HIV 感染者中肺动脉高压的筛查和监测提供临床决策依据。
