BACKGROUND - The epidemiology and prognostic impact of increased pulmonary pressure among HIV-infected individuals in the antiretroviral therapy era is not well described.
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.
RESULTS - PASP was reported in 2,831 HIV-infected and 5,465 HIV-uninfected veterans (follow up 3.8±2.6 years). As compared to uninfected veterans, HIV infected veterans with HIV viral load >500 copies/ml (odds ratio (OR)=1.27, 95% CI=1.05-1.54) and those with CD4 cell count<200 cells/mm3 (OR=1.28, 95% CI=1.02-1.60) had a higher prevalence of PASP≥40 mmHg. As compared to uninfected veterans with a PASP<40mmHg, HIV-infected veterans with a PASP≥40 mmHg had an increased risk of death (adjusted HR=1.78, 95% CI=1.57-2.01). This risk persisted even among participants without prevalent comorbidities (adjusted HR 3.61 95%CI 2.17-6.01). The adjusted risk of mortality in HIV-infected veterans was higher at all PASP values compared with 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 compared to 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 comorbidties. These findings may inform clinical decision making regarding screening and surveillance of PH in HIV-infected individuals.