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Am J Respir Crit Care Med. 2018 Apr 1;197(7):923-932. doi: 10.1164/rccm.201708-1555OC.

Increased Echocardiographic Pulmonary Pressure in HIV-infected and -uninfected Individuals in the Veterans Aging Cohort Study.

Author information

1
1 Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
2
2 Vanderbilt Translational and Clinical Cardiovascular Research Center, Nashville, Tennessee.
3
3 Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
4
4 Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
5
5 Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
6
6 Research Division, Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven, Connecticut.
7
7 Department of Emergency Medicine and.
8
8 Division of General Internal Medicine, Boston University, Boston, Massachusetts.
9
9 Division of Infectious Diseases, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
10
10 Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
11
11 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington.
12
12 Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
13
13 Division of Pulmonary and Critical Care Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
14
14 Department of Medicine, George Washington University School of Medicine, Washington, D.C.
15
15 Division of Infectious Diseases, Washington D.C. Veterans Affairs Medical Center, Washington, D.C.
16
16 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
17
17 Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, California; and.
18
18 Veterans Health Administration-Tennessee Valley Healthcare System Geriatrics Research Education Clinical Center, Nashville, Tennessee.

Abstract

RATIONALE:

The epidemiology and prognostic impact of increased pulmonary pressure among HIV-infected individuals in the antiretroviral therapy era is not well described.

OBJECTIVES:

To examine the prevalence, clinical features, and outcomes of increased echocardiographic pulmonary pressure in HIV-infected and -uninfected individuals.

METHODS:

This study evaluated 8,296 veterans referred for echocardiography with reported pulmonary artery systolic pressure (PASP) estimates from the Veterans Aging Cohort study, an observational cohort of HIV-infected and -uninfected veterans matched by age, sex, race/ethnicity, and clinical site. The primary outcome was adjusted mortality by HIV status.

MEASUREMENTS AND MAIN RESULTS:

PASP was reported in 2,831 HIV-infected and 5,465 HIV-uninfected veterans (follow-up [mean ± SD], 3.8 ± 2.6 yr). As compared with uninfected veterans, HIV-infected veterans with HIV viral load greater than 500 copies/ml (odds ratio, 1.27; 95% confidence interval [CI], 1.05-1.54) and those with CD4 cell count less than 200 cells/μl (odds ratio, 1.28; 95% CI, 1.02-1.60) had a higher prevalence of PASP greater than or equal to 40 mm Hg. As compared with uninfected veterans with a PASP less than 40 mm Hg, HIV-infected veterans with a PASP greater than or equal to 40 mm Hg had an increased risk of death (adjusted hazard ratio, 1.78; 95% CI, 1.57-2.01). This risk persisted even among participants without prevalent comorbidities (adjusted hazard ratio, 3.61; 95% CI, 2.17-6.01). The adjusted risk of mortality in HIV-infected veterans was higher at all PASP values than in uninfected veterans, including at values currently considered to be normal.

CONCLUSIONS:

HIV-infected people with high HIV viral loads or low CD4 cell counts have a higher prevalence of increased PASP than uninfected people. Mortality risk in HIV-infected veterans increases at lower values of PASP than previously recognized and is present even among those without prevalent comorbidities. These findings may inform clinical decision-making regarding screening and surveillance of pulmonary hypertension in HIV-infected individuals.

KEYWORDS:

echocardiography; electronic health records; human immunodeficiency virus; patient outcome assessment; pulmonary hypertension

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