Pulmonary Hypertension Seen as Prevalent Among HIV-infected Patients in Africa

People infected with HIV are known to have a greater incidence of pulmonary hypertension and to be an almost 2,500-fold higher risk of developing PH than others, and a new study looked at HIV-infection and PH rates in Africa, a continent with the highest prevalence of HIV infections worldwide.

The study, “Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis,” was published in the journal BMJ Open, recommended that HIV patients be regularly assessed for pulmonary hypertension.

Because PH increases the risk for severe cardiac events, such as right heart failure, cardiogenic shock, and sudden death, HIV-infected patients with PH have higher mortality rates than the general population.

Africa carries the greatest burden of HIV infection globally,  accounting for nearly 70 percent of all HIV infections worldwide. Despite this, few studies have investigated the incidence and prevalence of PH in HIV-infected populations there.

Researchers examined the literature, and found that among the 121 studies identified as possibly relevant, published between Jan. 1, 1980, and June 30, 2016, only three met their criteria: one from Southern Africa (South Africa), one from Eastern Africa (Tanzania), and one from Central Africa (Cameroon).

HIV-infected adults in these studies ranged in age from 18 to 78, presented with cardiovascular symptoms, and were assessed for PH through echocardiography or right heart catheterization. A majority of the patients were women.

Results revealed that the pool prevalence of PH in the 664 examined patients was 14%, notably higher when compared to HIV patients in developed countries, where it is about 0.5%.

Researchers believe that this might occur because African HIV patients receive antiretroviral therapies at later disease stages than those in developed countries, possibly after such HIV-related complications as PH have already developed. With the new 2015 World Health Organization (WHO) recommendations for the initiation of antiretroviral therapies, these discrepancies in the prevalence on PH are expected to decrease.

The investigators point to some limitations in their study, including the small number of studies assessed, and the fact that it was not possible to compare the prevalence of PH in HIV patients who received antiretroviral therapies versus those who did not.

Nonetheless, the team concluded, “The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa.”