Abstract Introduction WHO Group 1 Pulmonary Arterial Hypertension (PAH) associated with HIV is well established. Evaluating for exacerbators of pulmonary hypertension (PH), however, such as partial anomalous pulmonary venous return (PAPVR) with secundum atrial septal defect (ASD), is pivotal to management. Case Presentation A 38-year-old male with a history of untreated HIV (due to lack of insurance), polysubstance use, presented with 3 weeks of productive cough, subjective fevers, dyspnea, syncope, and rapidly progressive hypoxemia requiring high-flow oxygen. Labs showed BNP 6,127 with normal troponin and WBC. CT revealed a dilated pulmonary artery, partial anomalous pulmonary venous return (PAPVR), and ground-glass opacities. He tested positive for rhinovirus and was treated for presumed pneumonia. Right heart catheterization confirmed severe pre-capillary pulmonary hypertension (mPAP 66 mmHg, PAWP 15, PVR 16 WU) with RV dysfunction. TTE showed normal EF (65-70%), RV dilation, and septal flattening. Infectious and autoimmune workup was negative; HIV viral load was 161,000 (CD4 121). He was started on IV epoprostenol, milrinone, and aggressive diuresis, and transfer for VA ECMO was declined due to a lack of a pathway for heart and lung transplantation. There were challenges in uptitrating his vasodilators due to worsening hypotension and pressor requirements. Despite treatment, he deteriorated, suffered cardiac arrest, and died. Discussion With anti-retroviral medications, the field of HIV related care also engages in chronic disease management of cardiovascular conditions. The incidence of pulmonary hypertension in patients with HIV is 0.5% vs. 0.0015% in non-HIV patients. Clinicians must remember to consider pulmonary hypertension in the differential for patients with hypoxemia amongst the typical opportunistic infections related to HIV. For all PH patients, ruling out structural etiologies of pulmonary hypertension is important. In this case, his PAPVR could have been contributing to his acute deterioration though he did not have an ASD. In many cases, surgical correction is an option for these patients with a 10-year survival greater than 95%. His PH was likely exacerbated by infection. Finally, this patient also faced socioeconomic barriers due to lack of insurance coverage. Overall, HIV continues to be a challenging disease to treat because of chronic disease management with cardiovascular manifestations and ongoing issues with access to care. This abstract is funded by: n/a
D’Couto et al. (Fri,) studied this question.