Association between HIV and incident pulmonary hypertension in US Veterans: a retrospective cohort study
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Pulmonary hypertension incidence based on echocardiographic estimates of pulmonary artery systolic pressure in people living with HIV remains unstudied. We aimed to determine whether people living with HIV have higher incidence and risk of pulmonary hypertension than uninfected individuals. METHODS: In this retrospective cohort study, we evaluated data from participants in the Veterans Aging Cohort Study (VACS) referred for echocardiography with baseline pulmonary artery systolic pressure measures of 35 mm Hg or less. Incident pulmonary hypertension was defined as pulmonary artery systolic pressure higher than 35 mm Hg on subsequent echocardiogram. We used Poisson regression to estimate incidence rates (IRs) of pulmonary hypertension by HIV status. We then estimated hazard ratios (HRs) by HIV status using Cox proportional hazards regression. We further categorised veterans with HIV by CD4 count or HIV viral load to assess the association between pulmonary hypertension risk and HIV severity. Models included age, sex, race or ethnicity, prevalent heart failure, chronic obstructive pulmonary disease, hypertension, smoking status, diabetes, body-mass index, estimated glomerular filtration rate, hepatitis C virus infection, liver cirrhosis, and drug use as covariates. FINDINGS: Of 21 314 VACS participants with at least one measured PASP on or after April 1, 2003, 13 028 VACS participants were included in the analytic sample (4174 [32%] with HIV and 8854 [68%] without HIV). Median age was 58 years and 12 657 (97%) were male. Median follow-up time was 3·1 years (IQR 0·9-6·8) spanning from April 1, 2003, to Sept 30, 2017. Unadjusted IRs per 1000 person-years were higher in veterans with HIV (IR 28·6 [95% CI 26·1-31·3]) than in veterans without HIV (IR 23·4 [21·9-24·9]; p=0·0004). The risk of incident pulmonary hypertension was higher among veterans with HIV than among veterans without HIV (unadjusted HR 1·25 [95% CI 1·12-1·40], p<0·0001). After multivariable adjustment, this association was slightly attenuated but remained significant (HR 1·18 [1·05-1·34], p=0·0062). Veterans with HIV who had a CD4 count lower than 200 cells per μL or of 200-499 cells per μL had a higher risk of pulmonary hypertension than did veterans without HIV (HR 1·94 [1·49-2·54], p<0·0001, for those with <200 cell μL and HR 1·29 [1·08-1·53], p=0·0048, for those with 200-499 cells per μL). Similarly, veterans with HIV who had HIV viral loads of 500 copies per mL or more had a higher risk of pulmonary hypertension than did veterans without HIV (HR 1·88 [1·46-2·42], p<0·0001). INTERPRETATION: HIV is associated with pulmonary hypertension incidence, adjusting for risk factors. Low CD4 cell count and high HIV viral load contribute to increased pulmonary hypertension risk among veterans with HIV. Thus, as with other cardiopulmonary diseases, suppression of HIV should be prioritised to lessen the burden of pulmonary hypertension in people living with HIV. FUNDING: National Heart, Lung, and Blood Institute (National Institutes of Health, USA); National Institute on Alcohol Abuse and Alcoholism (National Institutes of Health, USA).
Source: The Lancet Healthy Longevity
Institutions: University of Kentucky, Vanderbilt University Medical Center, University of Pittsburgh, VA Tennessee Valley Healthcare System, Boston University, University of Utah, VA Salt Lake City Healthcare System, University of Washington, VA Puget Sound Health Care System, University of Pennsylvania, Cornell University, VA Pittsburgh Healthcare System, Weill Cornell Medical College in Qatar, Weill Cornell Medicine, Yale University, James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, VA Connecticut Healthcare System
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,000
Awards: 4/6 COMpAAAS U01: Operations Research Study, G2615631298, 2/6 COMpAAAS U01: Observation Study, 3/6 COMpAAAS U01: Intervention Study, G4418003357, G4495890310, G4903055321, Alcohol Associated Outcomes Among HIV+/- Aging Veterans, G5109693148, G5904973511, 1/6 COMpAAAS U24: Coordinating Center, G6207429464, Clinical, Genetic, and Proteomic Risk Factors for Pulmonary Hypertension in Heart Failure, G8029522133, A molecular phenotype of combined pulmonary hypertension, Alcohol Associated Outcomes Among HIV+/-Aging Veterans, G833165568, Alcohol Associated Outcomes Among HIV+/-Aging Veterans, Tennessee Center for AIDS Research (TN-CFAR), The HIV and Alcohol Research center focused on Polypharmacy (HARP), Yale Clinical and Translational Science Award
OpenAlex ID: W3169501790