- Design
- Systematic review and meta-analysis of 12 cohorts
- Population
- 537 people with right heart catheterisation-confirmed HIV-associated PAH (1986 to 2021)
- Primary outcome
- Presentation, treatment use and survival over time
- Effect
- 64% received PAH-targeted therapy at diagnosis; survival improved over three decades
This systematic review and meta-analysis pooled 12 cohorts of right heart catheterisation-confirmed HIV-associated pulmonary arterial hypertension, with 537 patients spanning 1986 to 2021.
The condition presented with severe haemodynamics and advanced functional limitation. Only 64% received PAH-targeted therapy at diagnosis. Survival improved progressively over three decades alongside increasing use of such therapy.
The abstract does not give effect sizes, and the improvement over time may reflect better antiretroviral therapy, earlier diagnosis and other changes beyond PAH drugs. The authors say the findings support considering contemporary combination PAH therapy in people with HIV.
- Consider pulmonary hypertension in people with HIV and unexplained breathlessness.
- Confirm the diagnosis by right heart catheterisation before labelling PAH.
- Do not leave confirmed PAH untreated; discuss targeted therapy with a PH centre.
- Antiretroviral therapy continues alongside PAH therapy; check interactions.
Why it matters
A third of patients in the pooled cohorts did not receive targeted therapy at diagnosis, which is a gap clinicians can close.
Don't overread it
Pooled observational cohorts spanning 35 years cannot attribute improved survival to any single therapy.
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