Bauerle M, Schmitt M, Ropers D, Dechant C, Low P, Kalden JR, Manger B, Harrer T; International Conference on AIDS.
Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. TuPeB4510.
Department of Medicine III, University of Erlangen, 91054 Erlangen, Germany
BACKGROUND: Pulmonary hypertension (PH) has been described primarily in untreated HIV-1 infected patients. We describe two HIV-1 infected patients developing a severe PH on a successful HAART. Case 1: The homosexual patient with CMV retinitis was treated with IDV, D4T, 3TC and NVP. In addition, he received ganciclovir, IL-2 and a thymic hormone. His viral load could be suppressed and his depleted CD4 cells showed a strong increase. 1 year later he developed a severe PH. Open lung biopsy revealed a muscular hypertrophy of the arteries, but no plexiform PH, and an interstitial pneumonia with a positive CMV PCR despite a normal high - resolution CT scan. Despite CMV therapy, initiation of iloprost inhalation and the stop of PIs and NNRTIs, the patient died after 21 months from the PH. Case 2: The HIV-1 and Hepatitis C - infected female was successfully treated for NHL with 6 * CHOP. Viral load could be suppressed by combination of IDV, D4T, 3TC and NVP and her CD4 cells rose from 109/microl to 432/microl. Because of Hep. C infection an interferon therapy was initiated. 3 years after begin of HAART the patient developed a severe lypodystrophy syndrome and a severe PH. Open lung biopsy showed capillary rarefication and arterial hypertrophy, but no plexiform alteration of the arteries and no inflammatory process. Change of HAART and subsequent stop of HAART could improve lipodystrophy, but the severe PH persisted until a continuous intravenous therapy with iloprost dramatically improved the PH. CONCLUSION: 2 HIV-infected patients developed a severe PH on a successful HAART and treatment with cytokines. It only can be speculated whether the PH in these patients is associated with HAART or cytokine treatment. Further studies are necessary to reveal the prevalence and potential causes of PH in patients on HAART. Continuous intravenous infusion of iloprost can be an effective treatment of PH in HIV-1-infected patients.
Publication Types:
Keywords:
- Antiretroviral Therapy, Highly Active
- CD4-Positive T-Lymphocytes
- Cytomegalovirus Retinitis
- Female
- Ganciclovir
- HIV Infections
- HIV-1
- Humans
- Hypertension, Pulmonary
- Iloprost
- Lamivudine
- Stavudine
- Viral Load
- drug therapy
- therapy
Other ID:
UI: 102254251
From Meeting Abstracts