Echocardiographic assessment of systolic pulmonary arterial pressure in HIV-positive patients.

  • Mehrnaz Rasoulinejad Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Sina Moradmand Badie Department of Cardiology, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohammad Reza Salehi Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Ahmad Seyed Alinaghi Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
  • Seyed Ali Dehghan Manshadi Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Nahid Zakerzadeh Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
  • Maryam Foroughi Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
  • Fatemeh Jahanjo Amin Abad Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • Banafsheh Moradmand Badie Department of Public Health, School of Public Health, Flinders University, Flinders, South Australia.
Keywords: Echocardiography, HIV, Highly active Antiretroviral therapy, Pulmonary hypertension

Abstract

Pulmonary hypertension is rare but is one of the complications that occur due to HIV infection. Symptoms of HIV-associated pulmonary arterial hypertension are often non-specific but the main symptom of the disease is dyspnea. In this cross-sectional study, we measured systolic pulmonary arterial pressure (SPAP) by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort) in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5%) and 62 females (46.5%). The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401 cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4%) of them had SPAP ≤ 30 mmHg (normal), six (3.6%) had SPAP: 31-35 mmHg (borderline) and five (3%) had SPAP > 35 mmHg (pulmonary hypertension). Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study.

References

Guha S, Pande A, Mookerjee S, et al. Echocardiographic profile of ART naïve human immunodeficiency virus (HIV)infected patients in a tertiary care hospital inn Kolkata. Indian Heart J 2010;62(4):330-4.

Longo-Mbenza B, Seghers LV, Vita EK, et al. Assessment of ventricular diastolic function in AIDS patients from Congo: a Doppler echocardiographic study. Heart 1998;80(2):184-9.

Passalaris JD, Sepkowitz KA, Glesby MJ. Coronary artery disease and human immunodeficiency virus infection. Clin Infect Dis 2000;31(3):787-97.

Sims A, Frank L, Cross R, et al. Abnormal cardiac strain in children and young adults with HIV acquired in early life. J Am Soc Echocardiogr 2012;25(7):741-8.

Sliwa k, Carrington M J, Becker A, et al. Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study Cohort. Eur Heart J 2012; 33(7):866-874.

Hai-long D, Yi-bing L, Xue-feng G, et al. Bosentan and antiretroviral therapy in an HIV/HBV/HCV co infected with HIV related pulmonary arterial hypertension. Chin Med J 2013;126(6):1197-8.

Sitbon O, Combe CL, Delferaissy JF, et al. Prevalence of HIV related pulmonary arterial hypertension in the current antiretroviral therapy era. Am J Respir Crit Care Med 2008;177(1):108-113.

Doukky R, Y Lee WY, Ravilla M, et al. A novel expression of exercise induced pulmonary hypertension in human immunodeficiency virus patients: a pilot study. Open Cardiovasc Med J 2012;6(1):44-9.

Morris A, Gingo MR, George MP, et al. Cardiopulmonary function in individuals with HIV infection in the antiretroviral therapy era. AIDS 2012;26(6):731-40.

Prendergast BD. HIV and Cardiovascular Medicine. Heart 2003;89(7):793-800.

Barbaro G. Cardiovascular manifestations of HIV infection. J R Soc Med 2002;94(8):384-90.

Dube MP, Sprecher D, Henry WK, et al. Preliminary guidelines for the evaluation and management of dyslipidemia in adults infected with human immunodeficiency virus and receiving antiretroviral therapy: Recommendations of the adult AIDS clinical trial group cardiovascular disease focus group. Clin Infect Dis 2000;31(5):1216-24.

Powers AC. Diabetes Mellitus. In: Longo D, Fauci A, Kasper D, et al, editors. Harrison’s Principles of Internal Medicine. 18th ed. Philadelphia: McGraw-Hill Professional; 2011: p. 2968-70.

Bergman JM, Skorecki K. Chronic Kidney Disease. In: Longo D, Fauci A, Kasper D, et al, editors. Harrison’s Principles of Internal Medicine. 18th ed. Philadelphia: McGraw-Hill Professional; 2011: p. 2308-10.

Mondy EK, Gottdiener J, Overton ET, et al. High prevalence of echocardiographic abnormalities among HIV-infected persons in the era of highly active antiretroviral therapy. Clin Infect Dis 2011;52(3):378-86.

Schuster I, Thoni GJ, Ederhy S, et al. Subclinical cardiac abnormalities in human immunodeficiency virus-infected men receiving antiretroviral therapy. Am J Cardiol 2008;101(8):1213-7.

Parsaee M, Amin A, Nematollahi M, et al. Comparison of trans thoracic echocardiography and right heart catheterization for assessing pulmonary arterial pressure in patients with congenital or valvular heart defects. Iranian Heart J 2011;12(4):54-61.

How to Cite
1.
Rasoulinejad M, Moradmand Badie S, Salehi MR, Seyed Alinaghi SA, Dehghan Manshadi SA, Zakerzadeh N, Foroughi M, Jahanjo Amin Abad F, Moradmand Badie B. Echocardiographic assessment of systolic pulmonary arterial pressure in HIV-positive patients. Acta Med Iran. 52(11):827-830.
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