HIV-infected veterans with a pulmonary artery systolic pressure ≥40 mm Hg had a significantly increased risk of death compared to uninfected veterans with normal pressure (HR 1.78).
Observational (n=8,296)
Yes
Does HIV infection and increased pulmonary artery systolic pressure increase mortality in veterans referred for echocardiography?
HIV-infected veterans have a higher prevalence of increased pulmonary artery systolic pressure, which is associated with a significantly increased risk of mortality even at values currently considered normal.
Effect estimate: HR 1.78 (95% CI 1.57-2.01)
Absolute Event Rate: 178% vs 54%
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, 3.8 ± 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/μl (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.
Brittain et al. (Mon,) conducted a observational in HIV infection and pulmonary hypertension (n=8,296). HIV infection with increased pulmonary artery systolic pressure (≥40 mm Hg) vs. HIV-uninfected with normal pulmonary artery systolic pressure (<40 mm Hg) was evaluated on All-cause mortality (HR 1.78, 95% CI 1.57-2.01). HIV-infected veterans with a pulmonary artery systolic pressure ≥40 mm Hg had a significantly increased risk of death compared to uninfected veterans with normal pressure (HR 1.78).