Increased Echocardiographic Pulmonary Pressure in HIV-infected and -uninfected Individuals in the Veterans Aging Cohort Study
Increased Echocardiographic Pulmonary Pressure in HIV-infected and -uninfected Individuals in the Veterans Aging Cohort Study
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DOI：
10.1164/rccm.201708-1555oc
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发表时间：
2018-04-01
影响因子：
24.7
通讯作者：
Freiberg, Matthew
中科院分区：
文献类型：
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作者：
Brittain, Evan L.;Duncan, Meredith S.;Freiberg, Matthew
基本原理：在抗逆转录病毒治疗的时代，HIV感染者肺动脉压升高的流行病学和预后影响还没有得到很好的描述。目的：研究HIV感染者和未感染者超声心动图肺动脉压升高的患病率、临床特征和预后。方法：这项研究评估了8,296名接受超声心动图检查的退伍军人，这些退伍军人报告了来自退伍军人老龄队列研究的肺动脉收缩压（PASP）估计值，一个观察性队列的艾滋病毒感染和未感染的退伍军人匹配的年龄，性别，种族/民族，和临床网站。主要结果是HIV状态调整后的死亡率。测量和主要结果：在2，831例HIV感染和5，465例HIV未感染的退伍军人中报告了PASP（随访[平均值+/- SD]，3.86 +/- 2.6年）。与未感染的退伍军人相比，HIV病毒载量大于500拷贝/ml的HIV感染退伍军人（比值比，1.27; 95%置信区间[CI]，1.05-1.54）和CD 4细胞计数低于200个细胞/μ l的患者（比值比，1.28; 95%CI，1.02-1.60）有较高的患病率PASP大于或等于40毫米汞柱。与PASP小于40 mm Hg的未感染退伍军人相比，PASP大于或等于40 mm Hg的HIV感染退伍军人的死亡风险增加（校正风险比，1.78; 95% CI，1.57-2.01）。即使在没有普遍合并症的参与者中，这种风险也持续存在（校正的风险比，3.61; 95%CI，2.17-6.01）。调整后的风险，在艾滋病毒感染的退伍军人的死亡率高于所有的PASP值比未感染的退伍军人，包括在值目前被认为是normal.Conclusions：艾滋病毒感染的人与高HIV病毒载量或低CD 4细胞计数有较高的患病率增加PASP比未感染的人。HIV感染退伍军人的死亡风险在PASP值低于以前认识到的情况下增加，即使在那些没有流行合并症的人中也存在死亡风险。这些发现可能会告知临床决策的筛选和监测肺动脉高压的艾滋病毒感染者。
Rationale: The epidemiology and prognostic impact of increased pulmonary pressure among HIV-infected individuals in the antiretroviral therapy era is not well described.Objectives: To examine the prevalence, clinical features, and outcomes of increased echocardiographic pulmonary pressure in HIV-infected and -uninfected individuals.Methods: This study evaluated 8,296 veterans referred for echocardiography with reported pulmonary artery systolic pressure (PASP) estimates from the Veterans Aging Cohort study, an observational cohort of HIV-infected and -uninfected veterans matched by age, sex, race/ethnicity, and clinical site. The primary outcome was adjusted mortality by HIV status.Measurements and Main Results: PASP was reported in 2,831 HIV infected and 5,465 HIV-uninfected veterans (follow-up[mean +/- SD], 3.86 +/- 2.6 yr). As compared with uninfected veterans, HIV-infected veterans with HIV viral load greater than 500 copies/ml (odds ratio, 1.27; 95% confidence interval [CI], 1.05-1.54) and those with CD4 cell count less than 200 cells/mu l (odds ratio, 1.28; 95% CI, 1.02-1.60) had a higher prevalence of PASP greater than or equal to 40 mm Hg. As compared with uninfected veterans with a PASP less than 40 mm Hg, HIV-infected veterans with a PASP greater than or equal to 40 mm Hg had an increased risk of death (adjusted hazard ratio, 1.78; 95% CI, 1.57-2.01). This risk persisted even among participants without prevalent comorbidities (adjusted hazard ratio, 3.61; 95% CI, 2.17-6.01). The adjusted risk of mortality in HIV-infected veterans was higher at all PASP values than in uninfected veterans, including at values currently considered to be normal.Conclusions: HIV-infected people with high HIV viral loads or low CD4 cell counts have a higher prevalence of increased PASP than uninfected people. Mortality risk in HIV-infected veterans increases at lower values of PASP than previously recognized and is present even among those without prevalent comorbidities. These findings may inform clinical decision-making regarding screening and surveillance of pulmonary hypertension in HIV-infected individuals.