Effect of gender and highly active antiretroviral therapy on HIV-related pulmonary arterial hypertension: results of the HIV-HEART Study

Background Idiopathic pulmonary arterial hypertension (PAH) is a rare disease. HIV-infected patients exhibit a considerably higher rate of development of this condition compared to the general population. Methods This cross-sectional study of 802 (83.4% male; age 44.3 +/- 10.3 years) HIV-positive patients aimed to evaluate the male-to-female ratio in HIV-related PAH and to elucidate whether PAH is more likely to occur in patients receiving highly active antiretroviral therapy (HAART) than in HIV-treatment-naive patients. All patients were examined by Doppler echocardiography to estimate systolic pulmonary arterial pressure (sPAP). Manifest PAH was defined as sPAP > 35 mmHg at rest in combination with symptoms of dyspnoea. Results A total of 38 (4.7%) patients were diagnosed with elevated sPAP > 35 mmHg. Fourteen (1.7%; 11 male) of these patients presented with symptoms of dyspnoea, resulting in a male-to-female ratio of manifest HIV-associated PAH of 1:1.4. Patients with symptoms of dyspnoea and sPAP > 35 mmHg were more likely to receive HAART (13/14 patients). Conclusions In HIV patients, sPAP occurs more frequently than has been reported previously; the condition is possibly associated with HAART. Furthermore, HIV-positive females exhibit a higher prevalence of HIV-related PAH (HIV-PAH) than HIV-positive males.