Exercise pulmonary hypertension in asymptomatic patients with HIV infection Insights from the RIGHT-NET registry

Background: Asymptomatic patients with Human Immunodeficiency Virus (HIV) infection may remain at increased risk for pulmonary vascular disease. We therefore explored the pulmonary circulation in these patients using exercise stress echocardiography. Methods: One hundred and fifty subjects from the RIGHT-NET registry were studied with exercise echocardiography: 37 with HIV infection and no overt pulmonary hypertension (PH), 48 with connective tissue disease (CTD) as disease-related latent PH controls, and 65 healthy controls. CTD and healthy controls were matched to HIV patients using propensity score matching based on age and sex. Exercise echocardiography followed standard protocols, with derived assessments of mean pulmonary arterial pressure (mPAP), cardiac output (CO), and mPAP/CO slopes. Results: During exercise, the HIV and CTD patients reached higher mPAP than healthy controls (35.2±5.9 and 30±4±7.7 mmHg vs 24.4±7.3 mmHg respectively, p<0.01). The mPAP/CO slope was abnormal (>3 mmHg/L/min) in 32.4% of HIV, 45.8% of CTD, and only 12.3% of healthy subjects. Tricuspid annular plane systolic excursion (TAPSE) and its ratio to systolic PAP were not different between the three study groups at resting. No associations were found between mPAP/CO slope or echocardiographic indices of right or left ventricular function and HIV viral load, CD4+ count, or antiretroviral therapy duration. Conclusions: We conclude that exercise stress echocardiography of the pulmonary circulation in asymptomatic HIV infection may commonly be associated with a latent PH, as in asymptomatic CTD.