PH and HIV

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What do I need to know about pulmonary hypertension in connection with HIV?

Although pulmonary hypertension and HIV are two separate conditions, some HIV patients have developed pulmonary hypertension, a condition called HIV-associated PAH. Scientists are continuing to study this to see if there is a connection, and what that connection might be.

The first case of pulmonary hypertension in an HIV-infected individual was reported in 1987, and since that time research has been ongoing. About 150 patients with HIV infection and pulmonary arterial hypertension have been reported since that time. It is possible that there are other unreported cases.

Because the first several HIV-PAH cases that were reported had occurred in patients with hemophilia (a congenital tendency to have uncontrolled bleeding), researchers originally (and incorrectly) thought that the cause of HIV-PAH was the hemophilia itself or perhaps had to do with problems associated with the hemophilia.

However, since that time, more HIV-PAH cases have been found in patients who do not have hemophilia at all. Therefore, scientists have decided that the development of pulmonary hypertension in HIV patients is in some way related to the HIV infection itself.

How common is the combination of HIV and PAH?

PAH is still an uncommon complication of HIV infection. As research into HIV continues and as new and better therapies are developed to combat the disease, HIV patients are living longer lives. As a result, the chance that an HIV-positive individual may develop PAH may increase as time goes on.

We can still safely say that PH occurs more frequently in the HIV-infected population than it does in those who do not have HIV. Thus, idiopathic pulmonary arterial hypertension (pulmonary hypertension that results from unknown causes, in this case an HIV-negative group of people), occurs less frequently than it does in those who are HIVinfected. Those who are infected with HIV have roughly six to 12 times the occurrence of PAH than the uninfected general population.

Who is most susceptible to a combination of HIV and PH?

HIV-PAH occurs more frequently in males, and in a slightly older individual than is usually seen in IPAH. In studies of HIV-PAH, the most frequent risk factors for HIV were intravenous drug use (45%), homosexual contact (25%), hemophilia (12%) and heterosexual contact (10%). Smaller numbers of cases have been identified in which the risk for HIV infection is blood transfusion, HIV passed from mother to child during pregnancy, or a combination of homosexual contact and intravenous drug use.

A high rate of stimulant use (methamphetamine or cocaine, depending on the region of the country) is common among individuals who are both HIV-infected and afflicted with PAH. (As a side note, intravenous drug use is also associated with development of pulmonary hypertension, even without HIV infection).

Does having HIV make PH worse?

There doesn’t seem to be any data to indicate that HIV makes PH worse. The usual symptoms of HIV-PAH are similar to those in other individuals with PAH, shortness of breath being the most common.

Does PH make HIV worse?

It’s hard to say. When tested, some HIV patients who also suffer from PH have lower pulmonary artery pressures than those who have PH alone; despite this, their survival rate appears worse. Medical professionals are not sure whether this has to do with a combination of the two conditions, or whether other problems associated with HIV contribute to the lower survival rate.

Why do PH and HIV seem to occasionally occur together, then?

This is another question that medical science is searching for. We do know that many HIV-infected individuals have other problems and other risk factors that can lead to PH. A direct cause and effect relation between HIV infection and pulmonary hypertension has not yet been found, and proteins associated with HIV have not yet been found in the lining of the blood vessels of the lungs.

Medical researchers have not yet been able to say for sure what role HIV infection plays in the development of PAH. It is not yet known, for example, whether HIV itself can directly cause pulmonary hypertension, or whether HIV is simply a trigger for the development of PAH in susceptible individuals. HIV remains a complicated disease that can cause many problems that weaken blood vessels, and these, too, can play into the development of PAH.

Should an HIV patient be tested for pulmonary hypertension?

HIV patients know that medical supervision is critical to their best possible long-term health, and that any change in their condition should be brought to the attention of their doctors.

Changes that may have to do with PH might include difficulty when attempting physical activity, swelling of the feet, ankles, legs or abdomen, increased shortness of breath, worsening fatigue, chest discomfort or pain, light-headedness or fainting. However, because these symptoms are general and may have to do with several types of problems, the patient’s doctor should always be contacted.

How is testing for PH carried out?

An echocardiogram is a useful screening tool; unfortunately, it alone is not accurate enough to make the diagnosis of HIV-PAH. A test known as right heart catheterization remains the most accurate way of diagnosing HIV-PAH.

Can pulmonary hypertension be treated the same way in HIV patients as in those without HIV?

Researchers are working to find the answer to this question, but to date, there have been few studies done with HIV patients who have PAH. The fact that the population of HIV-PAH patients is very small has been a problem for researchers.

Another problem has been that the long-term survival of HIV-PAH patients is lower than those who have PH without the addition of HIV. In all cases, however, the sooner PH (or any other complicating problem) is diagnosed in an HIV patient, the better the outlook is for the patient.