Pulmonary Arterial Hypertension in HIV
Pulmonary arterial hypertension (PAH) is a debilitating condition that occurs more frequently in HIV-infected patients compared to the general population and is associated with increased morbidity and mortality. There is no clear relationship with CD4 counts or HIV viral load, and the mechanisms that lead to PAH in this population are not well defined. A high index of suspicion is essential and should prompt referral to a specialized center for further evaluation and management. There are notable drug-drug interactions between certain antiretroviral therapies and medications like sildenafil and bosentan. Despite the absence of carefully controlled trials of PAH in the HIV population, the approach to management mirrors the therapeutic strategy for patients with other causes of group 1 PAH. It prioritizes the early and aggressive implementation of PAH-specific therapies, often with combinations from different classes, similar to the current treatment paradigm for HIV in the era of antiretroviral therapy.
KeywordsPulmonary arterial hypertension Human immunodeficiency virus Right ventricular failure Pulmonary arteriopathy Prostacyclins Right heart catheterization
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