PURPOSE:Pulmonary arterial hypertension (PAH) is a devastating disease with a higher prevalence in those with Acquired Immune Deficiency Syndrome (AIDS). Although several studies have assessed the prevalence of PAH in this population, there are very few which look for pulmonary arteriopathy at autopsy, a possible harbinger of PAH.
METHODS:H&E lung autopsy slides from 38 individuals, ages 28–50, who died with AIDS were obtained from the National Cancer Institute’s AIDS and Cancer Specimen Resource. As controls, H&E lung autopsy slides from 25 individuals, ages 22–54, without HIV/AIDS were obtained from the Kansas University Department of Pathology. These slides were examined by a pulmonary pathologist to look for signs of arteriopathy (medial and intimal hypertrophy and/or plexiform lesions). Findings were correlated with clinical information, looking for other conditions which may have led to pulmonary arteriopathy (CHF/ventricular hypertrophy, chronic hypoxemia, mitral stenosis, IVDU or intravascular foreign material, stimulant abuse, pulmonary vasculitis, pulmonary fibrosis, pulmonary sarcoidosis, tumor emboli, sickle cell anemia, and cirrhosis).
RESULTS:AIDS and control groups showed nearly identical prevalence of pulmonary arteriopathy at death, 31.6% vs. 32.0%. However, the prevalence of arteriopathy in those without risk factors (unexplained arteriopathy) appeared higher in the AIDS group, 23.7% vs. 4.0%, RR=5.92 (0.80–43.90). Of individuals who had arteriopathy, those with AIDS seemed less likely to have another known risk factor as compared to controls, 12.5% vs. 75%, RR=6.00 (0.93–38.63).
CONCLUSION:The overall prevalence of pulmonary arteriopathy is similar in individuals with HIV/AIDS as compared to age-matched controls undergoing autopsy. However, individuals who die with AIDS have a higher prevalence of otherwise unexplained pulmonary arteriopathy than those dying without HIV/AIDS. Of individuals with arteriopathy at autopsy, those with AIDS are less likely to have another risk factor.
CLINICAL IMPLICATIONS:Our findings demonstrate early, unrecognized changes in the pulmonary vascular bed of individuals with HIV/AIDS and may warrant an increased concentration of effort focused on the role of HIV in PAH and the consideration of an intensified screening program in this population.
DISCLOSURE:Jay Montgomery, None.