Risk factors associated with pulmonary arterial hypertension among HIV-infected adults: A meta-analysis and systematic review.

Abstract

Pulmonary arterial hypertension (PAH) occurs more frequently in patients with HIV infection than in general population. The predictive value of HIV-related factors and traditional cardiovascular factors with PAH is inconsistent across studies. The objective is to determine the roles of HIV-related risk factors and traditional cardiovascular risk factors in the development of PAH in adults with HIV. We searched Pubmed/Medline, Embase, Web of Science, and Google Scholar to identify studies published between January 1, 2000 and February 23, 2021 on risk factors associated with PAH among people living with HIV (PLWH). Ten studies were included for final analysis. PLWH with PAH had higher mean age (weighted mean difference [WMD] = 2.27, 95% confidence interval [CI] 0.31 ~ 4.24), and lower mean CD4 cell count (WMD = -95.8, 95% CI -153.41 ~ -38.2). Meanwhile, they were more likely to have detectable viral load (odds ratio [OR] = 1.36, 95% CI 1.16 ~ 1.60), to accompany arterial hypertension (OR = 2.02, 95% CI 1.51 ~ 2.71) and less likely to receive antiretroviral therapy (ART) (OR = 0.84, 95% CI 0.72 ~ 0.99). Besides, more intravenous drug users were observed in HIV-infected adults with PAH (OR = 2.25, 95% CI 1.51 ~ 3.33). HIV infection itself and ART impact PAH in two opposite ways. Traditional cardiovascular factors such as arterial hypertension, and older age are also important to the development of PAH. Screening HIV-related factors and traditional cardiovascular factors may help to target and manage patients at risk.