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HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study

Opravil, M.
Speich, R.
Joller-Jemelka, H. I.
Jenni, R.
Russi, E. W.
Luthy, R.
Published in American journal of respiratory and critical care medicine. 1997, vol. 155, no. 3, p. 990-995
Abstract To assess the clinical and echocardiographic time course, prognosis, and possible etiology of HIV-associated primary pulmonary hypertension (PPH), we prospectively followed all 19 patients in whom PPH was diagnosed in our centers. Women (12 cases) and injecting drug use (16 cases) predominated; the median CD4 lymphocytes count was 83/microliter (range, 1 to 740). Matched control subjects without PPH were identified within the Swiss HIV Cohort Study. Frozen serum samples of both groups were then reanalyzed for autoimmune parameters, neopterin, beta-2-microglobulin, and thyroid-stimulating hormone. The median follow up of the patients was 1.3 yr. Follow-up Doppler echocardiography was available in 13 patients. The RVSP-RAP pressure gradient decreased by 3.2 mm Hg for those six patients who received antiretroviral treatment but increased by 19.0 mm Hg for untreated patients (p = 0.026). PPH was the cause of eight of 17 deaths. The probability of surviving was significantly decreased in patients with PPH in comparison with the control subjects; the median survival was 1.3 versus 2.6 yr (p < 0.05). Patients with PPH had significantly higher anticardiolipin IgM, anti SS-B, and neopterin, but all other laboratory values did not differ between cases and control subjects. In conclusion, HIV-associated PPH contributed significantly to mortality. Antiretroviral treatment may exert a beneficial effect on the pressure gradient. A possible role of an autoimmune phenomenon in the pathogenesis could not be substantiated.
Keywords AdultAnti-HIV Agents/therapeutic useAntibodies, Anticardiolipin/analysisCase-Control StudiesDidanosine/therapeutic useEchocardiography, DopplerEnzyme-Linked Immunosorbent AssayFemaleHIV Infections/ complications/drug therapy/mortalityHumansHypertension, Pulmonary/ complications/immunology/mortality/ultrasonographyImmunoglobulin M/analysisMaleProspective StudiesSurvival RateZidovudine/therapeutic use
PMID: 9117037
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OPRAVIL, M. et al. HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study. In: American journal of respiratory and critical care medicine, 1997, vol. 155, n° 3, p. 990-995. https://archive-ouverte.unige.ch/unige:9409

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Deposited on : 2010-07-12

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