- Design
- Systematic review and meta-analysis of cohort studies
- Population
- 12 cohorts, 537 people with catheter-confirmed HIV-associated PAH, 1986 to 2021
- Primary outcome
- Haemodynamics, treatment at diagnosis and survival trends
- Effect
- 64% on targeted therapy at diagnosis; survival improved progressively over three decades
A meta-analysis pooled 12 cohorts of HIV-associated pulmonary arterial hypertension confirmed by right heart catheterisation, 537 patients in total, covering 1986 to 2021.
Patients typically presented with severe haemodynamics and advanced functional limitation. Only 64% were on pulmonary hypertension-targeted therapy at diagnosis. Survival improved steadily across the three decades, in parallel with wider use of targeted therapy and, over the same period, effective antiretroviral treatment.
The condition is rare, and the improvement over time is an association, so the review cannot separate the effect of targeted therapy from better HIV care. The practical point is diagnostic: unexplained breathlessness in a person with HIV deserves an echocardiogram, because the disease is usually advanced by the time it is found.
- Consider pulmonary hypertension in a person with HIV who has breathlessness out of proportion to lung findings
- Request an echocardiogram early; patients in these cohorts were usually diagnosed late
- Refer suspected cases to a pulmonary hypertension centre for right heart catheterisation
- Check interactions between antiretrovirals and pulmonary hypertension drugs, especially with boosted regimens
Why it matters
A third of patients were not on targeted therapy at diagnosis, despite having severe disease.
Don't overread it
The link between therapy use and survival is observational and confounded by improvements in HIV care.
The statistics, in plain English
Cohort data pooled over 35 years show trends, not cause and effect. Survival rising alongside therapy use does not prove the therapy caused the gain, since HIV treatment improved at the same time.
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