TY - JOUR
T1 - Increased echocardiographic pulmonary pressure in HIV-infected and -uninfected individuals in the veterans aging cohort study
AU - Brittain, Evan L.
AU - Duncan, Meredith S.
AU - Chang, Joyce
AU - Patterson, Olga V.
AU - DuVall, Scott L.
AU - Brandt, Cynthia A.
AU - So-Armah, Kaku A.
AU - Goetz, Matthew
AU - Akgun, Kathleen
AU - Crothers, Kristina
AU - Zola, Courtney
AU - Kim, Joon
AU - Gibert, Cynthia
AU - Pisani, Margaret
AU - Morris, Alison
AU - Hsue, Priscilla
AU - Tindle, Hilary A.
AU - Justice, Amy
AU - Freiberg, Matthew
N1 - Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - 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.
AB - 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.
KW - Electronic health records echocardiography
KW - Human immunodeficiency virus
KW - Patient outcome assessment
KW - Pulmonary hypertension
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U2 - 10.1164/rccm.201708-1555OC
DO - 10.1164/rccm.201708-1555OC
M3 - Article
C2 - 29131651
AN - SCOPUS:85045209279
SN - 1073-449X
VL - 197
SP - 923
EP - 932
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 7
ER -
