ArticleThe lancet. Healthy longevity2021
Association between HIV and incident pulmonary hypertension in US Veterans: a retrospective cohort study.
Article in The lancet. Healthy longevity, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed, 15 citations in OpenAlex.
- Food insecurity and cardiometabolic diseases among people with HIV in West Africa.AIDS (London, England) · 2026Article
- HIV-Associated Pulmonary Arterial Hypertension in Resource-Limited Settings: A "Forgotten" Diagnosis, a Great Imitator, and a Multi-Hit Pulmonary Vasculopathy.Pulmonary circulation · 2026Review
- The New Era of Pulmonary Hypertension: The Dawn of Disease Modification & Therapeutic Modalities.Journal of cardiovascular development and disease · 2026Review
- Echocardiography in HIV Disease.Current cardiology reports · 2026Review
- Review
- Article
- Rare but serious: pulmonary vascular disease around the world.JHLT open · 2025Review
- Global Landscape of Infection-Induced Pulmonary Hypertension.Infectious disease reports · 2025Review
- Definition, classification and diagnosis of pulmonary hypertension.The European respiratory journal · 2024Article
- Elevated blood pressure and hyperuricemia risk: a retrospective cohort study from Wuhu, China.Scientific reports · 2024Article
- HIV and Global Cardiovascular Health.Current cardiology reports · 2022Review
- Mice with humanized immune system as novel models to study HIV-associated pulmonary hypertension.Frontiers in immunology · 2022Article
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14 authors at 12 institutions in 2 countries.
Funding
Abstract
backgroundPulmonary hypertension incidence based on echocardiographic estimates of pulmonary artery systolic pressure in people living with HIV remains unstudied. We aimed to determine whether people living with HIV have higher incidence and risk of pulmonary hypertension than uninfected individuals.
methodsIn this retrospective cohort study, we evaluated data from participants in the Veterans Aging Cohort Study (VACS) referred for echocardiography with baseline pulmonary artery systolic pressure measures of 35 mm Hg or less. Incident pulmonary hypertension was defined as pulmonary artery systolic pressure higher than 35 mm Hg on subsequent echocardiogram. We used Poisson regression to estimate incidence rates (IRs) of pulmonary hypertension by HIV status. We then estimated hazard ratios (HRs) by HIV status using Cox proportional hazards regression. We further categorised veterans with HIV by CD4 count or HIV viral load to assess the association between pulmonary hypertension risk and HIV severity. Models included age, sex, race or ethnicity, prevalent heart failure, chronic obstructive pulmonary disease, hypertension, smoking status, diabetes, body-mass index, estimated glomerular filtration rate, hepatitis C virus infection, liver cirrhosis, and drug use as covariates.
findingsOf 21 314 VACS participants with at least one measured PASP on or after April 1, 2003, 13 028 VACS participants were included in the analytic sample (4174 [32%] with HIV and 8854 [68%] without HIV). Median age was 58 years and 12 657 (97%) were male. Median follow-up time was 3·1 years (IQR 0·9-6·8) spanning from April 1, 2003, to Sept 30, 2017. Unadjusted IRs per 1000 person-years were higher in veterans with HIV (IR 28·6 [95% CI 26·1-31·3]) than in veterans without HIV (IR 23·4 [21·9-24·9]; p=0·0004). The risk of incident pulmonary hypertension was higher among veterans with HIV than among veterans without HIV (unadjusted HR 1·25 [95% CI 1·12-1·40], p<0·0001). After multivariable adjustment, this association was slightly attenuated but remained significant (HR 1·18 [1·05-1·34], p=0·0062). Veterans with HIV who had a CD4 count lower than 200 cells per μL or of 200-499 cells per μL had a higher risk of pulmonary hypertension than did veterans without HIV (HR 1·94 [1·49-2·54], p<0·0001, for those with <200 cell μL and HR 1·29 [1·08-1·53], p=0·0048, for those with 200-499 cells per μL). Similarly, veterans with HIV who had HIV viral loads of 500 copies per mL or more had a higher risk of pulmonary hypertension than did veterans without HIV (HR 1·88 [1·46-2·42], p<0·0001).
interpretationHIV is associated with pulmonary hypertension incidence, adjusting for risk factors. Low CD4 cell count and high HIV viral load contribute to increased pulmonary hypertension risk among veterans with HIV. Thus, as with other cardiopulmonary diseases, suppression of HIV should be prioritised to lessen the burden of pulmonary hypertension in people living with HIV.
fundingNational Heart, Lung, and Blood Institute (National Institutes of Health, USA); National Institute on Alcohol Abuse and Alcoholism (National Institutes of Health, USA).
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