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Highly active antiretroviral therapy compared with HAART and bosentan in combination in patients with HIV-associated pulmonary hypertension
  1. G Barbaro1,
  2. A Lucchini2,
  3. A M Pellicelli3,
  4. B Grisorio4,
  5. G Giancaspro5,
  6. G Barbarini6
  1. 1Cardiology Unit, Department of Medical Pathophysiology, University La Sapienza, Rome, Italy
  2. 2ALT-ONLUS, Melzo, Italy
  3. 3Department of Internal Medicine, S Camillo Hospital, Rome, Italy
  4. 4Division of Infectious Diseases, General Hospital, Foggia, Italy
  5. 5Department of Emergency Medicine, University La Sapienza, Rome, Italy
  6. 6Department of Infectious and Parasitic Diseases, Policlinico S Matteo, Pavia, Italy
  1. Correspondence to:
    Dr Giuseppe Barbaro
    Viale Anicio Gallo 63, 00174 Rome, Italy; g.barbaro{at}tin.it

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Pulmonary arterial hypertension (PAH) is an increasingly recognised complication of HIV disease. The effects of highly active antiretroviral therapy (HAART) on the clinical course of HIV-associated PAH are still debated.1 Bosentan, a dual endothelin 1 receptor antagonist, may be an effective approach to treatment of PAH in both HIV-uninfected and HIV-infected patients.2–4 We report the results of an open-label, six-month prospective,observational, preliminary study of previously untreated HIV-infected patients with PAH. They were followed up to assess the effect of HAART compared with HAART and bosentan in combination on their exercise capacity and cardiopulmonary haemodynamic parameters.

METHODS

Previously untreated HIV-infected patients with PAH were elegible for the study. The patients were screened by clinical examination and tranthoracic echocardiography. Patients with an echocardiographic right ventricular systolic pressure > 35 mm Hg underwent right heart catheterisation. PAH was defined on the basis of mean pulmonary artery pressure (mPAP) at rest > 25 mm Hg, pulmonary capillary wedge pressure < 15 mm Hg and pulmonary vascular resistance > 240 dyn·s·cm−5 by right heart catheterisation.4 Exclusion criteria were age < 18 years; history of drug addiction and use of drugs known to have a definite cardiotoxic action (for example, cocaine and amphetamines); recent HIV-associated opportunistic infections; previous treatment with antiretroviral or immunomodulating drugs, or both; history of chronic obstructive pulmonary disease (assessed by analysis of clinical records and by pulmonary function tests); previous congenital or acquired heart disease (assessed by analysis of clinical records …

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