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Patients with concomitant HIV and pulmonary hypertension experience worse outcomes versus patients with HIV alone, including higher in-hospital mortality.

Patients with concomitant HIV and pulmonary hypertension (PH) experience worse outcomes compared with patients with HIV alone, including higher in-hospital mortality, longer length of stay, and increased healthcare costs, according to results published in the International Journal of Cardiology.

“The mortality and morbidity were assumed to be high in [patients with HIV and PAH],” the researchers wrote. “There exists no data [on] the outcomes of this subset of the population as of today, to the best of our knowledge.”

Researchers used data from the National Inpatient Sample to identify patients with both HIV and pulmonary hypertension. The analysis included 910,120 patients with HIV; 28,175 (3.19%) were found to have concurrent PH.

Impact of PH on Outcomes

Compared with those with HIV alone, patients with HIV and PH were older (54.53 vs 49.44), mostly Black (64.45% vs 51.8%%), and more often men (57.2%; all P<0.001).

Patients in the HIV-PH cohort had higher Charlson Comorbidity Index scores (7.07±3.53 vs 5.17±3.65), slightly longer length of stay (adjusted mean difference [aMD], 0.79), and a greater healthcare burden (adjusted for inflation; aMD, $17,065). These findings were all highly significant (P<0.001).

Univariate regression analysis showed that patients with HIV and PH had significantly higher rates of developing the following conditions:

• heart failure (adjusted OR [aOR], 10.44);
  • cardiogenic shock (aOR, 5.67);
  • cardiomyopathy (aOR, 4.97);
  • in-hospital cardiac arrest (aOR, 1.94);
  • respiratory failure (aOR, 3.29);
  • aspiration pneumonia (aOR, 1.29);
  • acute kidney injury (aOR, 2.14).

Patients with HIV and PV were also more likely to require invasive mechanical ventilation (aOR, 1.71), and they had higher in-hospital mortality within 30 days of admission (aOR, 1.28) as well as higher overall in-hospital mortality (aOR, 1.23; P<0.005).

Implications for Clinicians

The findings indicate an increased risk for associated comorbid conditions in patients with HIV and PH can lead to worse clinical outcomes, researchers noted.

“This increased risk [for] adverse outcomes highlights the need for early detection and management of this condition,” the researchers wrote. “Regular screening for PH in patients with HIV, especially in those with risk factors such as older age, male sex, and Black race, should be considered.”