Right ventricular load and contractility in HIV-associated pulmonary hypertension

• Published in: PloS one Vol. 16; no. 2; p. e0243274
• Main Authors: Rajaratnam, Arun, Rehman, Sofiya, Sharma, Prerna, Singh, Vikas K, Saul, Melissa, Vanderpool, Rebecca R, Gladwin, Mark T, Simon, Marc A, Morris, Alison
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23-02-2021; Public Library of Science (PLoS)
• Subjects: Adult; Biology and Life Sciences; Cardiac Catheterization; Complications and side effects; Development and progression; Female; Health aspects; Heart diseases; Heart ventricle, Right; HIV - isolation & purification; HIV infection; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - physiopathology; HIV Infections - virology; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - virology; Kaplan-Meier Estimate; Male; Medicine and Health Sciences; Middle Aged; Myocardial Contraction; Physiological aspects; Pulmonary Arterial Hypertension - diagnosis; Pulmonary Arterial Hypertension - etiology; Pulmonary Arterial Hypertension - physiopathology; Pulmonary Arterial Hypertension - virology; Pulmonary hypertension; Retrospective Studies; Risk factors; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology; Ventricular Dysfunction, Right - virology; Viral Load; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243274

People living with human immunodeficiency virus (PLWH) are at risk of developing pulmonary hypertension (PH) and right ventricular (RV) dysfunction, but understanding of the relationship of RV function to afterload (RV-PA coupling) is limited. We evaluated the clinical and hemodynamic characteristics of human immunodeficiency virus (HIV)-associated PH.
We performed a retrospective review of patients with a diagnosis of HIV undergoing right heart catheterization (RHC) from 2000-2016 in a tertiary care center. Inclusion criteria were diagnosis of HIV, age ≥ 18 years and availability of RHC data. PH was classified as either pulmonary arterial hypertension (PAH; mean pulmonary arterial pressure [mPAP] ≥ 25mmHg with pulmonary artery wedge pressure [PAWP] ≤ 15mmHg) or pulmonary venous hypertension (PVH; mPAP ≥ 25mmHg with PAWP > 15). We collected demographics, CD4 cell count, HIV viral load, RHC and echocardiographic data. The single beat method was used to calculate RV-PA coupling from RHC.
Sixty-two PLWH with a clinical likelihood for PH underwent RHC. Thirty-two (52%) met PH criteria (15 with PAH, 17 with PVH). Average time from diagnosis of HIV to diagnosis of PH was 11 years. Eleven of 15 individuals with PAH were on antiretroviral therapy (ART) while all 17 patients with PVH were on ART. Compared to PLWH without PH, those with PH had an increased likelihood of having a detectable HIV viral load and lower CD4 cell counts. PLWH with PAH or PVH had increased RV afterload with normal RV contractility, and preserved RV-PA coupling.
PLWH with PH (PAH or PVH) were more likely to have a detectable HIV viral load and lower CD4 count at the time of RHC. PLWH with PAH or PVH had increased RV afterload, normal RV contractility, with preserved RV-PA coupling suggestive of an early onset, mild, and compensated form of PH. These results should be confirmed in larger studies.