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Master Thesis

Hypertension artérielle pulmonaire associée au VIH‎ : survie et facteurs pronostiques actuels‎ : étude rétrospective de 77 cas d'octobre 2000 à janvier 2008

Abstract : Objectives: To examine baseline characteristics and outcome of patients with pulmonary arterial hypertension (PAH) associated with HIV infection (PAH-HIV) in the modern era of highly active antiretroviral therapy (HAART) and specific PAH therapy. Methods: We retrospectively reviewed data of 77 consecutive PAH-HIV patients without other associated risk factor for PAH referred to the French Reference Center for Pulmonary Hypertension between October 2000 and January 2008. Results were expressed as median [1st-3rd quartile].Results: At diagnosis of PAH, 81% of patients were on HAART, 79% had a CD4+ count >200 cells.mm-3 and 49% had undetectable HIV load. NYHA FC assessment was as follows: II (18%), III (73%), IV (9%). 6-min walk distance (6MWD) was 375 [288-421] m, and pulmonary vascular resistance (PVR) 689 [524-852] dyn.s.cm-5. HAART was given in all patients irrespective of their HIV status. PAH specific therapy was started in 50 patients and led after 29 [12-59] months to improvement in 6MWD (369 [290-416] to 469 [410-526] m, p< 0.0001) and PVR (800 [576-950] to 332 [226-596] dyn.s.cm-5, p<0.0001). In patients who did not receive PAH specific therapy, 6MWD improved after 37 [8-48] months (400 [331-454] to 429 [399-497] m, p<0.05), but haemodynamics did not change. Overall survival rates were 88% and 72% at 1 and 3 years, respectively. On multivariate analysis, cardiac index>2.8 L.min-1.m-2 and CD4+ lymphocyte count>200 cells.mm-3 were independent predictors of survival. Conclusions: Survival of PAH-HIV patients in the modern therapeutic era dramatically improved compared with previous reports. Prognosis in PAH-HIV is mainly related to CD4+ lymphocyte count and to cardiac function.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00633925
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Submitted on : Wednesday, October 19, 2011 - 6:14:38 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:16 AM
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  • HAL Id : dumas-00633925, version 1
  • PPN : 155752359

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Mathilde Guillaume. Hypertension artérielle pulmonaire associée au VIH‎ : survie et facteurs pronostiques actuels‎ : étude rétrospective de 77 cas d'octobre 2000 à janvier 2008. Médecine humaine et pathologie. 2009. ⟨dumas-00633925⟩

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