Advances in the diagnosis and treatment of HIV-associated pulmonary arterial hypertension

ABSTRACT

Introduction

HIV-associated pulmonary arterial hypertension (HIV-PAH) is an increasingly recognized complication of HIV, with a significant degree of associated morbidity and mortality. Given a wide array in the severity of clinical presentations, the prompt diagnosis and subsequent initiation of therapies has remained a challenge in this rare condition.

Areas covered

Diagnosis of HIV-PAH has been primarily established by transthoracic echocardiogram and right heart catheterization. There are several viral proteins that have been implicated in the pathogenesis of this condition that could be developed as either alternative or complimentary diagnostics in the evaluation of this condition. Therapy for HIV-PAH is centered on the management of HIV as well as the use of standard PAH therapies. The caveats in this distinct patient population include the consideration of drug-drug interactions of therapy with highly active antiretroviral therapy (HAART) and rare use of calcium channel blockers.

Expert opinion

Further research into the pathogenesis of HIV-PAH is warranted in order to develop diagnostics and therapy directed at the viral proteins implicated in this condition. This will be integral to the future evaluation and management of this unique patient population.

KEYWORDS:

• HIV-PAH
• HIV
• viral proteins
• Tat protein
• Nef protein
• plexiform lesions
• HAART

Article highlights

• HIV-associated pulmonary arterial hypertension (HIV-PAH) is a serious complication of HIV that leads to right heart failure and subsequent death.

• Timely diagnosis and treatment remain challenging, with therapy hinged around the management of HIV with HAART as well as standard PAH therapies including phosphodiesterase type 5 inhibitors, guanylate cyclase stimulants, endothelin receptor antagonists and prostacyclin agonists.

• Care must be taken to appropriately use calcium channel blockers and evaluate potential drug–drug interactions between HAART and PAH medications in these patients.

• Several HIV proteins implicated in the pathogenesis of this disease process, including Tat and Nef proteins, could pose as the target of future diagnostic and therapeutic efforts.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.