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HIV-related pulmonary hypertension. A case report and literature review

Abstract number: 903_r2259

Panagopoulos P.

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Background:

Isolated pulmonary hypertension is a rare manifestation of HIV infection, with a reported frequency of 0.5% among HIV infected patients. To date more than 200 symptomatic cases have been reported. Diagnosis is not related to CD4 count or HIV-RNA levels, prognosis is unfavourable and the mean survival is 6 months. Standard therapy includes oxygen administration and vasodilating agents. Sildenafil has also been used since 1998. The effect of HAART is unknown.

Purpose:

To report a new case of HIV-related pulmonary hypertension in an asymptomatic patient presenting with low oxygen saturation.

Case presentation:

36-year-old male, heavy smoker (60 pack/years), diagnosed as HIV-positive 5 years ago (CDC stage C3), with poor compliance to antiretroviral treatment. He presented in the outpatient HIV clinic totally asymptomatic. His vital signs were normal except for low O2 saturation (85–88%). Clinical findings were unremarkable, and his laboratory tests and electrocardiogram normal. His CD4 count was 24/mm3 and HIV-RNA 1 500 000 copies/mL. The high-resolution chest CT showed emphysematic lungs and spirometry revealed final bronchiolar disease without obstructive pulmonary disease. The transthoracic cardiac ultrasound documented severe pulmonary hypertension (systolic pulmonary arterial pressure ~63 mmHg). He refused to undergo pulmonary catheterisation. All risk factors for secondary pulmonary hypertension were excluded in this patient (addiction to iv drugs, interstitial pulmonary disease, chronic obstructive disease or acute infection) and the diagnosis of HIV-related pulmonary hypertension was established. Diltiazem and HAART regimen were administered, but, once discharged from the unit, he did not adhere to the treatment. Eight months later, he is hospitalised due to worsening dyspnoea.

Conclusion:

HIV-Pulmonary Hypertension should be included in the differential diagnosis in patients with pulmonary hypertension and respiratory failure, despite the absence of typical symptoms.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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