Primary pulmonary hypertension associated with human immunodeficiency viral infection

Coplan, Neil L.; Shimony, Rony; Ioachim, Harry L.; Wilentz, James R.; Posner, David; Lipschitz, Andrew; Ruden, Ronald A.; Bruno, Michael S.; Sherrid, Mark V.; Gaetz, Harold P.; Englard, Arthur; Kukin, Marrick; Packer, Milton

doi:10.1016/0002-9343(90)90105-m

Cited by 78 publications

(18 citation statements)

References 9 publications

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“…Although direct infection of the pulmonary vascular smooth muscle or endothelium with HIV-I could not be demonstrated in patients with PPH (6), HIV infection induces a chronic inflammatory state and persisting immune activation (26). This might trigger pulmonary arteriolar endothelial cell proliferation in susceptible patients by yet unknown mechanisms or as a result of growth factor stimulation as was speculated by Coplan and colleagues (4). Antiretroviral therapy downregulates viral replication in lymphoid tissue (27).…”

Section: Resultsmentioning

confidence: 99%

HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study.

Opravil

Péchère

Speich

et al. 1997

Am J Respir Crit Care Med

271

156

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To assess the clinical and echocardiographic time course, prognosis, and possible etiology of HIV-associated primary pulmonary hypertension (PPH), we prospectively followed all 19 patients in whom PPH was diagnosed in our centers. Women (12 cases) and injecting drug use (16 cases) predominated; the median CD4 lymphocytes count was 83/microliter (range, 1 to 740). Matched control subjects without PPH were identified within the Swiss HIV Cohort Study. Frozen serum samples of both groups were then reanalyzed for autoimmune parameters, neopterin, beta-2-microglobulin, and thyroid-stimulating hormone. The median follow up of the patients was 1.3 yr. Follow-up Doppler echocardiography was available in 13 patients. The RVSP-RAP pressure gradient decreased by 3.2 mm Hg for those six patients who received antiretroviral treatment but increased by 19.0 mm Hg for untreated patients (p = 0.026). PPH was the cause of eight of 17 deaths. The probability of surviving was significantly decreased in patients with PPH in comparison with the control subjects; the median survival was 1.3 versus 2.6 yr (p < 0.05). Patients with PPH had significantly higher anticardiolipin IgM, anti SS-B, and neopterin, but all other laboratory values did not differ between cases and control subjects. In conclusion, HIV-associated PPH contributed significantly to mortality. Antiretroviral treatment may exert a beneficial effect on the pressure gradient. A possible role of an autoimmune phenomenon in the pathogenesis could not be substantiated.

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Section: Resultsmentioning

confidence: 99%

HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study.

Opravil

Péchère

Speich

et al. 1997

Am J Respir Crit Care Med

271

156

View full text Add to dashboard Cite

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“…DILS is characterized by increased longevity, fewer opportunistic infections, and circulating lymphocytosis of antigenically driven CD8+ memory T cells, without the characteristic presenceof anti-Ro/SS-A and anti-La/SS-B autoantibodies found in idiopathic Sjogren's syndrome (13)(14)(15). In common with DILS, the patients with PPH and HIV infection did not have antinuclear antibodies and had fewer opportunistic infections (1)(2)(3)(4)(5)(6)(7)(8). The longevity of HIV-positive PPH reflects the severity of the pulmonary hypertension (PHT) (8).…”

Section: Discussionmentioning

confidence: 99%

“…Human immunodeficiency virus (HIV) infection is known to be associated with the development of primary pulmonary hypertension (PPH) (1)(2)(3)(4)(5)(6)(7)(8)(9), occurring in the absence of significant pulmonary or cardiac involvement. The predominant histopathologic finding has been plexogenic pulmonary arteriopathy (1-3, S, 6,8,9), although thromboembolic changes have also been reported (10).…”

mentioning

confidence: 99%

Primary pulmonary hypertension in HIV infection: an outcome determined by particular HLA class II alleles.

Morse¹,

Barst²,

Itescu³

et al. 1996

Am J Respir Crit Care Med

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Primary pulmonary hypertension (PPH) may have an autoimmune basis that is influenced by host immunogenetics. The pathogenesis of primary pulmonary hypertension in human immunodeficiency virus (HIV) infection is unclear. The objective of this study was to determine whether patients with PPH and HIV infection have distinctive immunogenetic profiles. Ten racially mixed HIV-infected patients with PPH were typed for human leukocyte antigen (HLA) class II (DRB1, 3, 4, 5 and DQB1) by DNA-PCR sequence-specific oligonucleotide probes. Results were compared with two control groups: 128 HIV-negative Caucasians and a previously reported group of 97 HIV-positive, racially mixed control subjects. In those with PPH, there was a significantly increased frequency of HLA-DR6 (-DRB1*1301/2 subtypes) and of HLA-DR52 (DRB3*0301 subtype). These findings suggest that HIV-associated PPH reflects a host response to HIV-1 determined by one or more HLA-DR alleles located within the major histocompatibility complex. The same HLA-DR6 subtype found at increased frequency in our patients has previously been associated with the development of a CD8 lymphocytic host response to HIV-1, termed diffuse infiltrative lymphocytosis syndrome (DILS), which resembles autoimmune Sjogren's disease and is associated with prolonged survival. Together, these findings suggest that HIV-positive PPH may represent a clinical outcome that has similarities with that resulting from the immunogenetically determined host response present in DILS.

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“…These early observations suggested the following clinical and pathological features for HIV-associated PAH [4][5][6][7]9 : Human Immunodeficiency Virus-Associated Pulmonary Arterial Hypertension …”

Section: First Observations Of Pulmonary Vascular Disease In Hiv Patimentioning

confidence: 99%

“…The symptoms are nonspecific, may not differ from other cases of PAH, such as progressive dyspnea, chest discomfort, dizziness, and syncope, and may not differ from those attributable to respiratory infections in the absence of fever. [4][5][6][7]9 According to the current guidelines, the clinical diagnosis and approach to an HIV patient with suspected pulmonary hypertension is similar to that used to diagnose PAH in the absence of HIV infection. 91 However, in developing countries where cardiac catheterization laboratories are often unavailable, clinicians should consider the possibility of PAH when HIV patients present with suggestive symptoms.…”

Section: Clinical Features Of Hiv-associated Pulmonary Arterial Hypermentioning

confidence: 99%

Human Immunodeficiency Virus–Associated Pulmonary Arterial Hypertension

Butrous

2015

Circulation

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Primary pulmonary hypertension associated with human immunodeficiency viral infection

Cited by 78 publications

References 9 publications

HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study.

HIV-associated primary pulmonary hypertension. A case control study. Swiss HIV Cohort Study.

Primary pulmonary hypertension in HIV infection: an outcome determined by particular HLA class II alleles.

Human Immunodeficiency Virus–Associated Pulmonary Arterial Hypertension

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