Advances in the diagnosis and treatment of HIV-associated pulmonary arterial hypertension

ABSTRACT Introduction HIV-associated pulmonary arterial hypertension (HIV-PAH) is an increasingly recognized complication of HIV, with a significant degree of associated morbidity and mortality. Given a wide array in the severity of clinical presentations, the prompt diagnosis and subsequent initiation of therapies has remained a challenge in this rare condition. Areas covered Diagnosis of HIV-PAH has been primarily established by transthoracic echocardiogram and right heart catheterization. There are several viral proteins that have been implicated in the pathogenesis of this condition that could be developed as either alternative or complimentary diagnostics in the evaluation of this condition. Therapy for HIV-PAH is centered on the management of HIV as well as the use of standard PAH therapies. The caveats in this distinct patient population include the consideration of drug-drug interactions of therapy with highly active antiretroviral therapy (HAART) and rare use of calcium channel blockers. Expert opinion Further research into the pathogenesis of HIV-PAH is warranted in order to develop diagnostics and therapy directed at the viral proteins implicated in this condition. This will be integral to the future evaluation and management of this unique patient population.