Increased echocardiographic pulmonary pressure in HIV-infected and -uninfected individuals in the veterans aging cohort study

Abstract

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. MeasurementsandMainResults:PASPwas reported in2,831HIVinfectedand5,465HIV- uninfectedveterans (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 withCD4 cell count less than 200 cells/ml (odds ratio, 1.28; 95%CI, 1.02-1.60) had a higher prevalence ofPASPgreater than or equal to 40 mm Hg. As compared with uninfected veterans with a PASP less than 40mmHg,HIV-infected veteranswith a PASP greater than or equal to 40mmHg had an increased risk of death (adjusted hazard ratio, 1.78;95%CI, 1.57-2.01).This riskpersisted evenamongparticipants 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 valuesthan inuninfectedveterans, includingat values currentlyconsidered 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.