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

Am J Respir Crit Care Med. 1997 Mar;155(3):990-5. doi: 10.1164/ajrccm.155.3.9117037.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antibodies, Anticardiolipin / analysis
  • Case-Control Studies
  • Didanosine / therapeutic use
  • Echocardiography, Doppler
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / mortality
  • Humans
  • Hypertension, Pulmonary / complications*
  • Hypertension, Pulmonary / diagnostic imaging
  • Hypertension, Pulmonary / immunology
  • Hypertension, Pulmonary / mortality
  • Immunoglobulin M / analysis
  • Male
  • Prospective Studies
  • Survival Rate
  • Zidovudine / therapeutic use


  • Anti-HIV Agents
  • Antibodies, Anticardiolipin
  • Immunoglobulin M
  • Zidovudine
  • Didanosine