13 Isolated exercise-induced pulmonary hypertension is associated with clinical worsening and poor immunological control in HIV patients

Abstract

Abstract Aims Exercise-induced pulmonary hypertension (Ex-PH) may represent the earliest sign of pulmonary arterial hypertension (PAH) in human immunodeficiency virus (HIV) patients. We investigated its association with clinical and immunological status, virologic control, and response to antiviral therapy. Methods and results In 32 consecutive HIV patients with either low (n = 29) or intermediate probability (n = 3) of PH at rest, we evaluated the association of isolated Ex-PH with: time to HIV diagnosis; CD4+ T-cell count; clinical progression to acquired immunodeficiency syndrome (AIDS); development of resistance to antiretroviral therapy (ART); HIV RNA levels; time to beginning of ART; current use of protease inhibitors; combination of ART with boosters (ritonavir or cobicistat); immuno-virologic response to ART; and ART discontinuation. Isolated Ex-PH at stress echocardiography (ESE) was defined as absence of PH at rest and systolic pulmonary arterial pressure (sPAP) >45 mmHg or a > 20 mmHg increase during low-intensity exercise cardiac output (<10 l/min). In our cohort, 22% (n = 7) of the enrolled population developed Ex-PH which was inversely related to CD4+ T-cell count (P = 0.047), time to HIV diagnosis (P = 0.014) and time to onset of ART (P = 0.041). Patients with Ex-PH had a worse functional class than patients without Ex-PH (P < 0.001). Ex-PH and AIDS showed a trend (P = 0.093) to a direct relationship. AIDS patients had a higher pulmonary vascular resistance compared to patients without Ex-PH (P = 0.020) at rest echocardiography. Conclusions The presence of isolated Ex-PH associates with a worse clinical status and poor immunological control in HIV patients. Assessment of Ex-PH by ESE may help identify subgroups of HIV patients with a propensity to develop subclinical impairment of pulmonary circulation following poor control of HIV infection.