HIV Viral Loads May Affect Echocardiographic Pulmonary Pressure

Individuals who are HIV positive may be at a higher risk for increased pulmonary pressures and mortality at pulmonary pressure values considered normal and below the threshold for invasive therapy, according to a study published in the American Journal of Respiratory and Critical Care Medicine.

Researchers identified and observed a cohort of 8296 veterans (HIV positive, n=2831 and HIV negative, n=5465) referred for echocardiography with reported pulmonary artery systolic pressure (PASP) estimates, and matched them 1:2 by age, sex, race/ethnicity, clinical site, and same year enrollment.

The primary objective of the study was to determine the adjusted mortality of individuals based on their HIV status. 

In addition, the study sought to identify clinical features associated with increased pulmonary pressure and identify the pulmonary arterial pressure point associated with an increased mortality risk in HIV-positive and HIV-negative individuals. 

Study results showed a higher PSAP ≥40 mm Hg in veterans who were HIV positive with a viral load >500 copies/mL and with a CD4 cell count <200 cells/mm³ (odds ratio [OR], 1.27; 95% CI, 1.05-1.54 and OR, 1.28; 95% CI, 1.02-1.60, respectively). After adjusting for demographics, comorbidities, viral load, CD4 count, and antiretroviral therapy regimen, an increase in PSAP was found to increase risk for mortality significantly in veterans who were HIV positive (hazard ratio [HR], 1.30; 95% CI, 1.14-1.49; P <.001).

Further, it was found that even veterans who were HIV positive without prevalent comorbidities (adjusted HR, 3.61; 95% CI, 2.17-6.01) had an increased risk for death (adjusted HR, 1.78; 95% CI, 1.57-2.01) compared with those individuals who were HIV negative. Overall, mortality was found to be higher at all PASP values in those who were HIV positive, including at normal values. 

Investigators concluded that individuals who are HIV positive, “with high HIV viral loads or low CD4 counts have a higher prevalence of increased PASP compared [with] uninfected people.” Further, an overall higher mortality was found in individuals who were HIV positive at lower PASP, even without the presence of comorbidities. Clinicians should be aware of the increased mortality risk in people who are HIV positive and should consider implementing screening and surveillance of pulmonary hypertension in this population.

Reference

Brittain EL, Duncan MS, Chang J, et al. Increased echocardiographic pulmonary pressure in HIV-infected and uninfected individuals in the veterans aging cohort study [published online on November 13, 2017]. Am J Respir Crit Care Med. doi:10.1164/rccm.201708-1555OC