Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1 (5-Year IF – 2.0)
Journal Citation Indicator (JCI) (2023) – 0.4
Scopus CiteScore – 3.7 (CiteScore Tracker 3.8)
Index Copernicus  – 171.00; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 3, May-June, p. 475–481

doi: 10.17219/acem/62244

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Echocardiographic characteristics of pulmonary arterial hypertension in children with horizontally transmitted HIV

Anca Meda Georgescu1,A,B,C,D,E,F, Cosmin Moldovan2,C,D,E,F, Janos Szederjesi3,C,D,E,F, Dan Georgescu4,B,C,D,E,F, Leonard Azamfirei3,A,C,D,E,F

1 Infectious Diseases Clinic, University of Medicine and Pharmacy of Tirgu Mures, Romania

2 Department of Histology, University of Medicine and Pharmacy of Tirgu Mures, Romania

3 Intensive Care Clinic, University of Medicine and Pharmacy of Tirgu Mures, Romania

4 1st Internal Medicine Clinic, University of Medicine and Pharmacy of Tirgu Mures, Romania

Abstract

Background. The prevalence of primitive pulmonary arterial hypertension (PAH) in patients with human immunodeficiency virus infection (HIV) is estimated at approximately 0.5%, significantly higher than in the general population.
Objectives. This study aimed to assess the echocardiographic modifications in HIV-associated pulmonary arterial hypertension (PAH).
Material and Methods. A group of 117 patients, aged under 16, with horizontally transmitted HIV staged according to the U.S. Center for Disease Control and Prevention criteria, were included in this prospective study, with echocardiographic abnormalities in 79 children. The study group consisted of 27 HIV-infected patients with PAH, while the control group consisted of 38 patients with normal ultrasound features. The diagnostic criterion for PAH was the presence of a mean pulmonary artery pressure above 25 mm Hg, determined at 2 consecutive measurements having at least 6 months distance between them. All subjects underwent a complex echocardiographic assessment, including assessment of left and right ventricular hypertrophy and evaluation of left ventricular function, associated with determination of the immunological stage.
Results. We recorded the presence of PAH in 27 patients (23.08%), in whom an average value of 31.48 mm Hg was recorded for pulmonary artery pressure. All patients had mild forms of PAH. Age, gender and immunological stage showed no significant differences in the PAH group compared to patients in the control group. Right ventricular hypertrophy was encountered in 95.23% and left ventricular hypertrophy in 88.88% of the patients with PAH. Left ventricular dysfunction, a complication of pulmonary hypertension, was relatively rare (11.11%).
Conclusion. In children with HIV infection, PAH is present in a relatively mild form and does not correlate with the clinical and immunological stage of HIV infection, evolving as a seemingly primitive condition.

Key words

children, pulmonary arterial hypertension, HIV, ultrasonography

References (22)

  1. Sitbon O. HIV-related pulmonary arterial hypertension: Clinical presentation and management. AIDS. 2008;22(Suppl 3):S55–62.
  2. Klings ES, Farber HW. The pathogenesis of HIV-associated pulmonary hypertension. In: Barbaro G, Karger, ed. HIV Infection and the Cardiovascular System. Basel. 2003;71–82.
  3. Pellicelli AM, Palmieri F, Cicalini S, Petrosillo N. Pathogenesis of HIV-related pulmonary hypertension. Ann NY Acad Sci. 2001;946:82–94.
  4. Galie N, Hoeper MH, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2009;30:2493–2537.
  5. Kamps BS, Hoffmann C. CDC Classification System. In: Hoffmann C, Rockstroch JK, Kamps BS, eds. HIV Medicine. Paris: Flying Publisher. 2005:27–28.
  6. Feigenbaum H. Echocardiography. Lippincott Williams & Wilkins, 1994;658-681.
  7. Cicalini S, Chinello P, Cicini MP, Petrosillo N. Pulmonary arterial hypertension and HIV infection. AIDS. 2008;22:2219–2220.
  8. Koestenberger M, Ravekes W, Everett A, et al. Right ventricular function in infants, children and adolescents: Reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z-score values. J Am Soc Echocardiogr. 2009;22:715–719.
  9. Koestenberger M, Nagel B, Ravekes W, et al. Reference values of the tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z-score values, and comparison to the tricuspid annular plane systolic excursion. Am J Cardiol. 2011;109:116–121.
  10. Van der Hulst AE, Roest AA, Delgado V, et al. Relationship between temporal sequence of right ventricular deformation and right ventricular performance in patients with corrected tetralogy of Fallot. Heart. 2011;97:231–236.
  11. Levy PT, Mejia AAS, Machefsky A, et al. Normal ranges of right ventricular systolic and diastolic strain measures in children: A systematic review and meta-analysis. JASE. 2014;27:549–560.
  12. Kassem E, Humpl T, Friedberg MK. Prognostic significance of 2-dimensional, M-mode and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension. Am Heart J. 2013;165:1024–1031.
  13. Diógenes MS, Succi RC, Machado DM, Moisés VA, Novo NF, Carvalho AC. Cardiac longitudinal study of children perinatally exposed to human immunodeficiency virus type 1. Arg Bras Cardiol. 2005;85:233–240.
  14. Speich R, Jenni R, Opravil M, Pfab M, Russi EW. Primary pulmonary hypertension in HIV infection. Chest. 1991;100:1268–1271.
  15. Sitbon O, Lascoux-Combe C, Delfraissy JF, et al. Prevalence of HIV-related pulmonary arterial hypertension in the current antiretroviral therapy era. Am J Respir Crit Care Med. 2008;177:108–113.
  16. Hemelaar J, Gouws E, Ghys PD, Osmanov S. Global and regional distribution of HIV-1 genetic subtypes and recombinants in 2004. AIDS. 2006;20:13–23.
  17. Georgescu AM, Moldovan C, Azamfirei L, Georgescu D. Ultrasound and histopathological features of myocardial involvement in HIV infection in children. Rom J Morphol Embryol. 2014;55:3–6.
  18. Degano B, Guillaume M, Savale L, et al. HIV-associated pulmonary arterial hypertension: Survival and prognostic factors in the modern therapeutic era. AIDS. 2010;24:67–75.
  19. Zuber JP, Calmy A, Evison JM, et al. The Swiss HIV cohort study group pulmonary arterial hypertension related to HIV infection: Improved hemodynamics and survival associated with antiretroviral therapy. Clin Infect Dis. 2004;38:1178–1185.
  20. Morse JH, Barst RJ, Itescu S, et al. Primary pulmonary hypertension in HIV infection: An outcome determined by particular HLA class II alleles. Am J Respir Crit Care Med. 1996;153:1299–1301.
  21. Papita AM, Albu A, Fodor D, Bondor C, Itu C, Carstina D. Markers of preclinical vacular disease and left ventricular diastolic dysfunction in patients with HIV infection. Med Ultrason. 2012;14:10–18.
  22. Isiguzo GC, Okeahialam BN, Danbauchi SS, Odili AN, Iroezindu MO, Placi U. Contributions of pulmonary hypertension to HIV-related cardiac dysfunction. Indian Heart J. 2013;65:644–649.
© Wroclaw Medical University