Pulmonary Hypertension and HIV
Pulmonary hypertension is a rare condition, spontaneously arising more frequently in patients with HIV infection than in those without it. As patients with HIV disease live longer, clinicians will be faced with treating both illnesses in a growing number of persons.
Neil is a 37-year-old man who stopped using injection drugs in 1986. He works as a computer programmer. In 1996, he noted wasting and exertional dyspnea. He had no fever, cough, or chest pain. He had lost 6.75 kg (15 lb) and blamed a poor appetite. He had no medical history other than 10 years of injection drug use in the past. He took no medications. Examination revealed mild dyspnea at rest, a prominent S2, and clear lungs. A chest radiograph showed clear lungs with prominence of the pulmonary arteries (Figure 1). His resting oxygen saturation was 98% on room air and fell to 88% with ambulation. His laboratory data were unremarkable, but his HIV test result was positive, with a CD4 cell count of 180/µL and viral load of 54,000 copies/mL.
(Enlarge Image)
Chest posteroanterior and lateral films in a patient with a positive HIV test result demonstrate clear lungs with prominent hila and dilated pulmonary arteries. These findings are consistent with a diagnosis of pulmonary hypertension. (Illustration courtesy of the department of radiology, New York Presbyterian Hospital, New York.)
(Enlarge Image)
Chest posteroanterior and lateral films in a patient with a positive HIV test result demonstrate clear lungs with prominent hila and dilated pulmonary arteries. These findings are consistent with a diagnosis of pulmonary hypertension. (Illustration courtesy of the department of radiology, New York Presbyterian Hospital, New York.)
A fiberoptic bronchoscopic examination revealed no pulmonary lesions; culture and biopsy results were negative. Echocardiography showed an elevated right ventricular systolic pressure of 67 mm Hg and severe pulmonary hypertension. Neil's condition improved somewhat in the hospital with rest and oxygen administration, and a HAART regimen was begun. His viral load became undetectable, his CD4 cell count rose above 200/µL, and he has stayed with his initial regimen. He continues to have dyspnea with exertion but has remained stable since 1996.
Pulmonary hypertension is a rare condition, spontaneously arising more frequently in patients with HIV infection than in those without it. As patients with HIV disease live longer, clinicians will be faced with treating both illnesses in a growing number of persons.
Neil is a 37-year-old man who stopped using injection drugs in 1986. He works as a computer programmer. In 1996, he noted wasting and exertional dyspnea. He had no fever, cough, or chest pain. He had lost 6.75 kg (15 lb) and blamed a poor appetite. He had no medical history other than 10 years of injection drug use in the past. He took no medications. Examination revealed mild dyspnea at rest, a prominent S2, and clear lungs. A chest radiograph showed clear lungs with prominence of the pulmonary arteries (Figure 1). His resting oxygen saturation was 98% on room air and fell to 88% with ambulation. His laboratory data were unremarkable, but his HIV test result was positive, with a CD4 cell count of 180/µL and viral load of 54,000 copies/mL.
(Enlarge Image)
Chest posteroanterior and lateral films in a patient with a positive HIV test result demonstrate clear lungs with prominent hila and dilated pulmonary arteries. These findings are consistent with a diagnosis of pulmonary hypertension. (Illustration courtesy of the department of radiology, New York Presbyterian Hospital, New York.)
(Enlarge Image)
Chest posteroanterior and lateral films in a patient with a positive HIV test result demonstrate clear lungs with prominent hila and dilated pulmonary arteries. These findings are consistent with a diagnosis of pulmonary hypertension. (Illustration courtesy of the department of radiology, New York Presbyterian Hospital, New York.)
A fiberoptic bronchoscopic examination revealed no pulmonary lesions; culture and biopsy results were negative. Echocardiography showed an elevated right ventricular systolic pressure of 67 mm Hg and severe pulmonary hypertension. Neil's condition improved somewhat in the hospital with rest and oxygen administration, and a HAART regimen was begun. His viral load became undetectable, his CD4 cell count rose above 200/µL, and he has stayed with his initial regimen. He continues to have dyspnea with exertion but has remained stable since 1996.
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