PH raises risk of severe cardiac, respiratory issues in HIV patients

Black people, males seen to be at greater likelihood of both diseases

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by Andrea Lobo |

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Having pulmonary hypertension (PH) worsens the likelihood of potentially life-threatening cardiac and respiratory complications in people with human immunodeficiency virus (HIV) infection, a U.S. database study reported.

Its findings “can inform clinical practice and help healthcare providers make more informed decisions regarding the screening, diagnosis, and management of PH in patients with HIV,” the researchers wrote.

The study, “In-hospital outcomes of pulmonary hypertension in HIV patients: A population based cohort study,” was published in the International Journal of Cardiology.

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HIV infection is known to raise the risk of pulmonary hypertension

PH is characterized by high blood pressure in the pulmonary arteries, the blood vessels that supply the lungs. As a result, the heart’s right ventricle must work harder to pump blood, which can ultimately lead to heart failure.

Multiple studies indicate that people with HIV, the virus that can lead to AIDS, are at a higher risk of developing PH. However, “outcomes of HIV-infected patients with PH (HIV-PH) have not been well established,” the researchers noted.

Scientists in the U.S. analyzed data from the National Inpatient Sample — a large database covering hospitalized patients in all 50 states — to assess outcomes in HIV-PH patients, including mortality, healthcare burden, and resource utilization. Data collected extended from late 2015 through 2019.

A total of 910,120 people with HIV were identified, of whom 28,175 (3.2%) also had PH. These patients were predominantly of Black race (64.5%), older (54.5 vs. 49.4 years), and more often male than female (68% vs. 57.2%), compared with HIV patients without PH.

But “although HIV patients with PH were more likely to be male overall, there was a higher prevalence [of] female HIV patient who developed PH compared to female HIV patients without,” the researchers noted, adding this finding “is rarely described in literature thus far.”

HIV-PH patients had a higher (worse) Charlson comorbidity index score (mean of 7.07 vs. 5.17), an indication of mortality risk and the severity of comorbidities, or coexisting conditions. Likewise, in-hospital mortality was significantly higher in patients with both HIV and PH than in those with HIV alone (4% vs. 2.3%).

Significantly longer in-hospital stays (7.6 vs. 6.1 days), higher mean total hospital charges ($97,462.92 vs. $70,026.44), and a greater need for intubation (8.06% vs. 3.89%) or a tracheostomy (0.76% vs. 0.43%) — an opening in the windpipe — to help with breathing also were seen in HIV-PH patients relative to HIV alone.

To determine the association between PH and clinical outcomes in people with HIV, the researchers adjusted outcomes for potential confounders such as age, sex, race, comorbidity index, admission year, and hospital characteristics.

Higher risk of heart failure, cardiogenic shock, and cardiomyopathy evident

This analysis found that HIV-PH patients had a significantly higher risk of cardiac conditions, including a roughly 10 times higher risk of heart failure, a 5.7 times greater risk of cardiogenic shock (when the heart is unable to pump enough blood to the body), and a five times higher risk of cardiomyopathy (a condition affecting heart muscle). They also were almost twice as likely to go into cardiac arrest while hospitalized than HIV patients alone.

HIV-PH patients also were more likely to require invasive mechanical ventilation, and to develop respiratory failure and acute kidney injury. Their risk of in-hospital mortality was 23% higher, increasing to 28% within the first 30 days of hospital admission.

“This study adds to the growing body of evidence that suggests an increased risk of adverse outcomes in patients with HIV and PH,” the researchers wrote, adding it highlights the need for early detection and appropriate management of PH in people with HIV.

Screening HIV patients for PH should be considered, particularly for those with identified risk factors that include a more advanced age, male sex, and Black race, they added.

A Conversation With Rare Disease Advocates