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Canadian Journal of Cardiology

Pulmonary Hypertension in HIV

      Abstract

      Human immunodeficiency virus–associated pulmonary arterial hypertension (HIV-PAH) is important to recognize given its association with significant morbidity and mortality. With the introduction of antiretroviral therapy, the focus of disease management has largely shifted from treating immunodeficiency-related opportunistic infections to managing chronic cardiopulmonary complications. Symptoms are nonspecific, and a high index of clinical suspicion is needed to avoid significant delay in the diagnosis of HIV-PAH. Although several viral proteins have been implicated in the pathogenesis of HIV-PAH, the exact mechanism remains uncertain. Further studies are needed to elucidate precise pathogenic mechanisms, early diagnostic tools, and novel therapeutic targets to improve prognosis of this severe complication.

      Résumé

      Il est important de reconnaître l’hypertension artérielle pulmonaire (HTAP) associée au virus de l'immunodéficience humaine (VIH) compte tenu de son lien avec une morbidité et une mortalité élevées. L’arrivée des antirétroviraux a fait en sorte que l’attention se porte désormais bien plus sur la prise en charge des complications cardiopulmonaires chroniques que sur le traitement des infections opportunistes imputables à une immunodéficience. Les symptômes étant aspécifiques, l’indice de suspicion clinique doit être élevé pour éviter des retards indus dans le diagnostic de l’HTAP associée au VIH. Bien que plusieurs protéines virales aient été incriminées dans la pathogenèse de cette affection, son mécanisme exact reste nébuleux. Il faudra réaliser de nouvelles études pour élucider les processus pathologiques en cause, pour trouver des outils permettant un diagnostic précoce et découvrir de nouvelles cibles thérapeutiques afin d’améliorer le pronostic de cette grave complication.
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