Abstract 19510: Pulmonary Hypertension in HIV: Prognostic Impact and Risk Factors in a Large National Sample
Introduction: The prognostic impact of pulmonary hypertension (PH) in HIV+ individuals is not well described. Moreover, risk factors associated with the development of PH in HIV+ individuals are poorly understood.
Methods: We examined risk factors for PH and mortality among veterans in the Veterans Aging Cohort Study, a national sample of 1:2 matched HIV+ and HIV- individuals. PH was defined as pulmonary artery systolic pressure (PASP) > 40mmHg. We used a natural language processing algorithm (manually validated with 95% precision) to extract PASP from echocardiograms performed between 2004 and 2012. We calculated mortality rates by PH and HIV status and used Cox proportional hazard models to measure the association between PH and mortality after adjusting for confounders.
Results: PASP was reported in 2,350 HIV+ and 4,524 HIV- individuals (follow up 3.6±2.7 years). The prevalence of PH in HIV+ and HIV- subjects was 30% and 29%, respectively (p=0.45). The presence of PH nearly doubles the mortality rate regardless of HIV status. HIV+ veterans with PH had the highest mortality rates and adjusted risk of death (Table). Compared with HIV+ veterans without PH, HIV+ veterans with PH had an increased risk of death (HR 1.31, 95%CI 1.14-1.51) after adjusting for demographics, comorbid disease, and HIV specific risk factors. This risk persisted even among HIV+ individuals without prevalent stroke, CHF, COPD, diabetes, or renal disease (HR 1.59 95%CI 1.05-2.41, p = 0.028). Among HIV+ subjects, black race, hypertension, diabetes, renal disease, COPD, stroke, CHF, higher viral load, and regimens containing nucleotide reverse transcriptase inhibitors (NRTIs) were all associated with PH (all p <0.05).
Conclusions: PH is associated with increased mortality risk in HIV+ and HIV- veterans even after adjustment for known risk factors. For HIV+ veterans, in addition to established risk factors for PH, we found that black race, HIV viral load, and NRTI medications were associated with PH.
Author Disclosures: E.L. Brittain: None. J. Chang: None. K. Crothers: None. K. Akgun: None. C. Gibert: None. M. Goetz: None. J. Kim: None. M. Pisani: None. K. So-Armah: None. M. Duncan: None. A. Justice: None. M. Freiberg: None.
- © 2016 by American Heart Association, Inc.