Certain characteristics of chronic heart failure and pulmonary arterial hypertension in HIV-positive patients

Goryacheva O.G., Zubarev M.A.

ABSTRACT

Pulmonary arterial hypertension (PAH) occurs in up to 36.5% of HIV-infected individuals and contributes to the development of pulmonary complications. The aim of the study is to investigate the clinical, echocardiographic, and laboratory characteristics of patients with chronic heart failure (CHF) and HIV infection in the presence of PAH.

Methods. This study complied with the Declaration of Helsinki and was designed as a screening, cross-sectional, one-time clinical study. A total of 160 patients with HIV infection and CHF were examined, of whom 50% were diagnosed with PAH. The diagnosis of PAH was confirmed via echocardiography by determining a mean pulmonary artery pressure of ≥25 mmHg.

Results. Among the PAH patients with the background of CHF and HIV infection, there was a predominance of smokers and individuals who abused alcohol. These patients also had a higher prevalence of atrial fibrillation in their medical history. Diastolic dysfunction (DD), left ventricular hypertrophy, and left atrial dilation were more frequently observed in the PAH group. Tricuspid annular plane systolic excursion (TAPSE) was lower, while total peripheral vascular resistance (TPR) was higher in patients with PAH. Serum iron and transferrin levels were lower, and NT-proBNP levels were higher in CHF patients with HIV infection and PAH. Among HIV-infected patients with CHF, the odds of developing PAH were 2.38 times higher (95% CI: 1.238–4.584, p=0.010), while the risk of developing CHF in HIV-infected individuals with PAH was 1.63 times higher (95% CI: 1.090–2.45). For those diagnosed with heart failure with reduced ejection fraction (HFrEF <40%), the odds of diagnosing PAH increased 4.89 times (95% CI: 1.009–23.736; p=0.047), and the risk of developing HFrEF in the presence of PAH rose 1.77 times (95% CI: 1.250–2.530).

Conclusion. The prevalence of PAH among HIV-infected patients with CHF is 50%. In this context, DD is more pronounced, patients with HFrEF are more common, NTproBNP levels and TPR are higher. DD, HFrEF, left atrial dilatation, chronic kidney disease, pericardial effusion, and pleural effusion contribute to the development of PAH in HIV-infected individuals.

Keywords: HIV infection, chronic heart failure, pulmonary arterial hypertension, arterial stiffness, health status.

For citation:

Goryacheva O.G., Zubarev M.A. Certain characteristics of chronic heart failure and pulmonary arterial hypertension in HIV-positive patients. International Journal of Heart and Vascular Diseases. 2025. 13(45): 30- 37. DOI: 10.24412/2311-1623-2025-45-37-45