UPmémoires

English

Trends in the incidence of pulmonary arterial hypertension (PAH) associated with HIV infection over the past 15 years: data from the French pulmonary hypertension registry

Rationale: Pulmonary arterial hypertension (PAH) is a rare but severe complication of HIV infection. In France, it seems to be a decline in the incidence and severity at diagnosis of PAH in HIV patients since 2007, but no study has reported on the evolution of the epidemiology and characteristics of PAH associated with HIV (PAH-HIV) over the last decade.

Objectives: Describe the evolution of PAH incidence in the HIV population (PAH-HIV) since 2007, in parallel with the evolution of HIV and PAH epidemiology in France and describe the evolution of patient characteristics at diagnosis of PAH-HIV over the period 2007-2022, as well as the response to treatment, survival and prognostic factors.

Methods: We conducted an observational, restrospective study based on the French pulmonary hypertension (PH) registry. We reported the evolution of incidence of PAH-VIH between 2007 an 2022 as well as clinical, functional and hemodynamic characteristics. Annual incidence, response to PAH approved drugs and overall survival of patients with PAH-HIV have been analysed.

Results: Between 2007 and 2022, 251 PAH-HIV patients were registered in the French PH registry. The incidence of PAH-HIV has decreased since 2007 (23 new cases in 2007 vs. 7 in 2022, HIV representing 6,1% of all PAH cases in 2007 vs. 1.7% in 2022), while the incidence of PAH and HIV has remained stable. The phenotype of PAH-HIV patients has evolved at diagnosis as patients diagnosed since 2015 were older, more frequently smokers, with a higher BMI, and had less hepatic comorbidities. Hemodynamics appeared to be similar in patients diagnosed before and after 2015 as well as survival. We observed a significant hemodynamic response in the 77% patients who were reassessed.

Conclusion: Incidence of PAH-HIV has been declining since 2007, while the incidence of PAH and HIV has remained stable. Phenotype of PAH-HIV patients has changed. Earlier introduction of antiretroviral treatment regardless of CD4 count since 2015 could explain the lower incidence of PAH-HIV, but does not seem to have major impact on the hemodynamic severity and survival.

Keywords : pulmonary hypertension, pulmonary arterial hypertension, HIV, epidemiology, prognostic, inflammation.