Abstract
A systematic review and meta-analysis was conducted to estimate the prevalence of PH in adolescents and adults living with HIV at the global level. PubMed, EMBASE, Web of Science, and Global Index Medicus were searched to identify articles published until November 4, 2018. PH had to be investigated with transthoracic echography or right heart catheterization (RHC). A random-effects model was used to pool individual studies. Overall, 25 studies with 42,642 participants from 17 countries were included. One study reported the prevalence of PH among HIV-infected adults based on RHC: 0.5% (95% confidence interval (CI): 0.3–0.6). The global prevalence of PH based on echography was 8.3% (95% CI: 4.6–12.8; 22 studies) among HIV-infected adults. In subgroup analysis, there was no difference between regions, human development indicator, and HIV burden in countries. Among HIV-infected adolescents, the prevalence of PH based on echography was 14.0% (95% CI: 2.2–33.1; 2 studies). This study suggests a high prevalence of PH in the global adolescent and adult population infected with HIV. As such, PH in this vulnerable population should be prioritized by HIV healthcare providers, policy makers and stakeholders for improved detection, overall proper management and efficient control.
Highlights
To date, it is unclear whether HIV infection is a cause or contributor of Pulmonary hypertension (PH)
We considered studies in which PH had been diagnosed with right heart catheterization
Factors identified in bivariate analyses included increasing age, N-terminal-proB-type natriuretic peptide, female sex, detectable HIV viral load, hepatitis C virus infection, short duration of HIV infection, smoking, and longer exposure to antiretroviral treatment (Table 2)[12,26,28,29,34,36]. This first global systematic review and meta-analysis of data from 42,642 adolescents and adults living with HIV from 17 countries showed an overall PH prevalence of 8.3% in adults and 14.0% in adolescents, with substantial heterogeneity between studies
Summary
It is unclear whether HIV infection is a cause or contributor of PH. HIV-associated PH which is part of the group 1 classifications is an important form of lung disease which is usually overlooked in routine clinical practice due to non-specific symptoms especially at early stage[1]. The exact pathogenesis of HIV-associated PH is still unknown, but HIV proteins such as Tat and Nef are probably implicated. This condition has a poor prognosis, leading progressively to right heart failure and death[4]. To the very best of our knowledge, there is no previous study which has attempted to systematically summarize data on the burden of PH in the HIV population. Such knowledge would help healthcare providers, policy makers and stakeholders to improve detection, overall proper management and efficient control of PH in people living with HIV.
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