HIV-associated pulmonary arterial hypertension: survival and prognostic factors in the modern therapeutic era
HIV-associated pulmonary arterial hypertension: survival and prognostic factors in the modern therapeutic era
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DOI：
10.1097/qad.0b013e328331c65e
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发表时间：
2010-01-02
期刊：
影响因子：
3.8
通讯作者：
Sitbon, Olivier
中科院分区：
文献类型：
--
作者：
Degano, Bruno;Guillaume, Mathilde;Sitbon, Olivier
目的：在现代高效抗逆转录病毒治疗（HAART）和特异性肺动脉高压（PAH）治疗的时代，研究基线特征和结局，并确定影响肺动脉高压（PAH）伴HIV感染（PAH-HIV）患者生存率的变量。设计：回顾性分析无其他PAH相关危险因素的PAH-HIV患者的数据，并与以前的系列进行比较。对2000年10月至2008年1月期间在法国肺动脉高压参考中心接受治疗的77例连续患者的数据进行了审查。结果表示为中位数[第1-第3四分位数] values.Results：在PAH的诊断，81%的患者HAART，79%的CD 4（+）计数超过200个细胞/μ l和49%的HIV载量检测不到。纽约心脏协会功能分级评估为II级（22%）、III级（69%）和IV级（9%）。6分钟步行距离（6 MWD）为375 [288-421] m，肺血管阻力为689 [524-852] dyns/cm（5）。所有患者均接受HAART治疗，无论HIV疾病分期如何。50例患者开始接受特定PAH治疗，导致6 MWD和血液动力学参数改善。在未接受特定PAH治疗的患者中，6 MWD改善，但血流动力学未改变。总生存率为88%，1年和72%，3年。多变量分析显示，心脏指数大于2.8 l/min/m2和CD 4（+）淋巴细胞计数大于200 cells/mu l.Conclusion：HAART似乎不能改善PAH-HIV患者的血流动力学参数。PAH-HIV的预后主要与CD 4（+）淋巴细胞计数和心功能有关。(C)2010年Wolters Kluwer Health竖条Lippincott威廉姆斯&威尔金斯
Objectives: To examine baseline characteristics and outcome, and to determine variables affecting survival in patients with pulmonary arterial hypertension (PAH) associated with HIV infection (PAH-HIV) in the modern era of highly-active antiretroviral therapy (HAART) and specific PAH therapy.Design: Retrospective review of data from PAH-HIV patients without other associated risk factors for PAH, and comparison with previous series.Methods: Data were reviewed for 77 consecutive patients treated at the French Reference Centre for Pulmonary Hypertension between October 2000 and January 2008. Results were expressed as median [1st-3rd quartile] values.Results: At diagnosis of PAH, 81% patients were on HAART, 79% had a CD4(+) Count more than 200 cells/mu l and 49% had undetectable HIV load. New York Heart Association functional class assessment was II (22%), III (69%), and IV (9%). Six-minute walk distance (6MWD) was 375 [288-421] m, and pulmonary vascular resistance was 689 [524-852] dyns/cm(5). All patients received HAART irrespective of HIV disease stage. Specific PAH therapy was started in 50 patients and led to improvements in 6MWD and haemodynamic parameters. In patients who did not receive specific PAH therapy, 6MWD improved but haemodynamics did not change. Overall survival rate was 88% at I year and 72% at 3 years. On multivariate analysis, cardiac index more than 2.8 l/min per m(2) and CD4(+) lymphocyte count more than 200 cells/mu l were independent predictors of survival.Conclusion: In patients with PAH-HIV, HAART seems unable to improve haemodynamic parameters. Prognosis in PAH-HIV is mainly related to CD4(+) lymphocyte Count and cardiac function. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins