Exercise-induced pulmonary hypertension in HIV patients: Association with poor clinical and immunological status

Rosalinda Madonna; Silvia Fabiani; Riccardo Morganti; Arianna Forniti; Matteo Mazzola; Francesco Menichetti; Raffaele De Caterina

doi:10.1016/j.vph.2021.106888

Exercise-induced pulmonary hypertension in HIV patients: Association with poor clinical and immunological status

Vascul Pharmacol. 2021 Aug:139:106888. doi: 10.1016/j.vph.2021.106888. Epub 2021 Jun 26.

Authors

Rosalinda Madonna¹, Silvia Fabiani², Riccardo Morganti³, Arianna Forniti², Matteo Mazzola¹, Francesco Menichetti², Raffaele De Caterina⁴

Affiliations

¹ Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
² Infectious Disease Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
³ Institute of Epidemiology, University of Pisa, Pisa, Italy.
⁴ Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy. Electronic address: raffaele.decaterina@unipi.it.

PMID: 34182165
DOI: 10.1016/j.vph.2021.106888

Abstract

Background and aim: Exercise-induced pulmonary hypertension (Ex-PH) may represent the earliest sign of pulmonary arterial hypertension (PAH) in human immunodeficiency virus (HIV) patients. We investigated its association with clinical and immunological status, virologic control, and response to antiviral therapy.

Methods: In 32 consecutive HIV patients with either low (n = 29) or intermediate probability (n = 3) of PH at rest, we evaluated the association of isolated ExPH with: time to HIV diagnosis; CD4+ T-cell count; clinical progression to acquired immunodeficiency syndrome (AIDS); development of resistance to antiretroviral therapy (ART); HIV RNA levels; time to beginning of ART; current use of protease inhibitors; combination of ART with boosters (ritonavir or cobicistat); immuno-virologic response to ART; and ART discontinuation. Isolated ExPH at stress echocardiography (ESE) was defined as absence of PH at rest and systolic pulmonary arterial pressure (sPAP) >45 mmHg or a >20 mmHg increase during low-intensity exercise cardiac output (<10 L/min).

Results: In our cohort, 22% (n = 7) of the enrolled population developed ExPH which was inversely related to CD4+ T-cell count (p = 0.047), time to HIV diagnosis (p = 0.014) and time to onset of ART (p = 0.041). Patients with ExPH had a worse functional class than patients without ExPH (p < 0.001). ExPH and AIDS showed a trend (p = 0.093) to a direct relationship. AIDS patients had a higher pulmonary vascular resistance compared to patients without ExPH (p = 0.020) at rest echocardiography.

Conclusions: The presence of isolated ExPH associates with a worse clinical status and poor immunological control in HIV patients. Assessment of ExPH by ESE may help identify subgroups of HIV patients with a propensity to develop subclinical impairment of pulmonary circulation following poor control of HIV infection.

Keywords: Acquired immunodeficiency syndrome; Exercise-induced pulmonary hypertension; Human immunodeficiency virus; Stress echocardiography.

MeSH terms

Echocardiography
Exercise
HIV Infections* / complications
HIV Infections* / diagnosis
HIV Infections* / drug therapy
Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / etiology
Pulmonary Arterial Hypertension*