Chest
Clinical InvestigationsPrimary Pulmonary Hypertension in HIV Infection
Section snippets
Patients and Methods
Over a nine-month period (January to September 1990), we prospectively examined by bronchoscopy and/or echocardiography 74 consecutive HIV-infected patients for complaints due to cardiopulmonary impairment, ie, cough of ≥two weeks' duration, shortness of breath, and/or abnormal blood gas values, pulmonary infiltrates, cardiac murmurs, fever >38.5°C, or positive blood cultures not explained by extrathoracic infections. This patient group is part of a cohort of 1,200 HIV-positive subjects
Results
The six patients with a mean age of 30 ± 5 years (range, 24 to 37 years) include five female IV drug users and one male homosexual. The presenting symptoms lasting between one to six months consisted of pedal edema (n = 5) and/or dyspnea on exertion (n = 3) with syncope and palpitations (n = 1). Three patients suffered from symptomatic HIV disease (CDC IV) and in three the CD4 T lymphocytes in the peripheral blood were markedly decreased (Table 1). Pulmonary hypertension with RVSP of 58 ± 8 mm
Case Reports
This 37-year-old woman (case 2) had a history of IV drug abuse from 1974 to 1987. She presented in January 1990 with spastic paraparesis due to suspected HIV-associated myelopathy, thrombocytopenia, leukopenia, and mild pedal edema. Electrocardiography showed signs of right ventricular hypertrophy. Whereas a chest roentgenogram was normal one year before (Fig 1), cardiomegaly with prominence of the main pulmonary artery was visible at the time of hospital admission (Fig 1). The lung fields were
Discussion
Primary pulmonary hypertension is a rare disorder. Only 187 cases have been reported to the National Heart, Lung, and Blood Institute, Bethesda, Md, during a period of four years.5 The diagnosis is found in less than 0.25 to 1.1 percent of unselected right heart catheterizations.15 At the inpatient and outpatient clinic of our referring university hospital with a population area of more than one million, we see not more than five cases each year. Therefore, the observation of PPH in six
REFERENCES (16)
Cardiac complications in acquired immunodeficiency syndrome (AIDS): a review.
J Am Coll Cardiol
(1989)- et al.
Prevalent myocarditis at necropsy in the acquired immunodeficiency syndrome.
J Am Coll Cardiol
(1988) - et al.
Primary pulmonary hypertension associated with human immunodeficiency viral infection.
Am J Med
(1990) - et al.
Severe pulmonary hypertension and cor pulmonale in the acquired immunodeficiency syndrome.
Am J Cardiol
(1989) - et al.
Pulmonary hypertension and HIV infection.
Am J Med
(1990) - et al.
Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients.
Am J Coll Cardiol
(1985) - et al.
Pulmonary complications of the acquired immunodeficiency syndrome.
N Engl J Med
(1984) - et al.
Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study.
J Am Coll Cardiol
(1989)
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2021, Clinics in Chest MedicineCitation Excerpt :Many published cases followed, which showed that this association could occur in early and late stages of HIV infection, and that PAH may contribute to a rapid clinical decline in HIV. There also is `a male predominance, in contrast to the high female predominance in non-HIV pulmonary arterial hypertension.52–55 Early estimates from developed countries suggested that the prevalence of pulmonary hypertension in patients with HIV infection was 0.5% to 9.9%.53,56,57
Pathology of Pulmonary Arterial Hypertension
2021, Encyclopedia of Respiratory Medicine, Second EditionPerioperative Considerations for Patients Diagnosed With Pulmonary Hypertension Undergoing Noncardiac Surgery
2019, Journal of Perianesthesia NursingPulmonary Hypertension in HIV
2019, Canadian Journal of Cardiology
Reprint requests: Dr. Speich, Department of Internal Medicine, University Hospital, 8091 Zurich, Switzerland
Manuscript received October 29; revision accepted March 8.