Association between HIV and incident pulmonary hypertension in US Veterans: a retrospective cohort study.

Autor:	Duncan MS; Department of Biostatistics, University of Kentucky, Lexington, KY, USA; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Alcorn CW; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA., Freiberg MS; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA., So-Armah K; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA., Patterson OV; VA Informatics and Computing Infrastructure, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA., DuVall SL; VA Informatics and Computing Infrastructure, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA., Crothers KA; Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA., Re VL 3rd; Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Butt AA; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Weill Cornell Medical College, New York, NY, USA; Weill Cornell Medicine-Qatar, Doha, Qatar., Lim JK; Yale Liver Center and Section of Digestive Diseases, Yale University, New Haven, CT, USA., Kim JW; Department of Medicine, James J Peters VA Medical Center, Icahn School of Medicine at Mt Sinai, New York, NY, USA., Tindle HA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA., Justice AC; Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA., Brittain EL; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Jazyk:	angličtina
Zdroj:	The lancet. Healthy longevity [Lancet Healthy Longev] 2021 Jul; Vol. 2 (7), pp. e417-e425. Date of Electronic Publication: 2021 Jun 16.
DOI:	10.1016/s2666-7568(21)00116-1
Abstrakt:	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). Competing Interests: Declaration of interests We declare no competing interests. MSF, KS-A, OVP, and ELB declare grants to their institutions from the National Heart, Lung, and Blood Institute. VLR III is the president-elect of the International Society for Pharmacoepidemiology. AAB received grant funding from Gilead Science through the Veterans Health Foundation of Pittsburgh. Funders had no role in the content of the manuscript or the decision to submit for publication.
Databáze:	MEDLINE
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