Pulmonary HTN occurs in 0.06-2% of HIV patients and is associated with increased HIV mortality [JAMA 2008;299:324-331]
Prevalence of HIV-assocuated pulmonary HTN is not associated with CD4 count
Pulmonary arterial hypertension is a rare but well-established complication of HIV infection (32,33)
Epidemiologic data in the early 1990s, a time when therapy with highly active antiretroviral therapy was not yet available, indicated a prevalence of 0.5% (95% confidence interval: 0.10% to 0.50%) (34)
The prevalence of HIV-associated PAH was evaluated more recently and showed a stable prevalence of 0.46% (95% confidence interval: 0.32% to 0.64%) (35)
Human immunodeficiency virus-associated PAH has clinical, hemodynamic, and histologic characteristics similar to those seen in IPAH
The mechanism for the development of PH remains unclear. Because neither the virus nor viral DNA has been found in pulmonary endothelial cells, an indirect action of virus through secondary messengers such as cytokines, growth factors, endothelin, or viral proteins is strongly suspected.
Uncontrolled studies suggest that patients with severe HIV-associated PAH could benefit from bosentan or long- term infusion of epoprostenol (36,37). Interestingly, in a substantial number of cases, normalization of pulmonary vascular hemodynamics can be obtained with therapy indi- cated for PAH; this is very rarely seen in IPAH (38).