Characteristics of pulmonary arterial hypertension course in a female patient with HIV infection. A case report

Introduction . The development of pulmonary arterial hypertension (PAH) wor­sens the HIV infection course, patient’s condition and increases the risk of morta­lity. Timely initiation of antiretroviral therapy (ART), appropriate selection of specific PAH therapy, and follow-up predictably improve the prognosis of these patients. Brief description . This case report describes the characteristics of the disease onset and the nature of cardiac remodeling in a female patient with newly diagnosed HIV infection-­associated PAH. The patient’s complex presentation at the time of dia­gnosis included not only HIV infection without ART, but also severe right ventricular dysfunction and remodeling with excessive trabeculation and signs of myocardial noncompaction, mildly reduced left ventricular systolic function, elevated transami­nases and total blood protein due to the gamma globulin fraction, iron deficiency anemia, and a history of smoking. Given the ambiguous disease presentation, sildenafil monotherapy was chosen as initial PAH-specific therapy. With the initiation of sildenafil and ART, the patient achieved a low risk of mortality, maintained compensated underlying disease, and regression of PAH after two years of follow-up. Discussion . In the absence of ART and with progressive PAH, the patient develo­ped severe right ventricular dysfunction and excessive trabeculation. Despite the high mortality risk at the time of diagnosis verification, sildenafil monothe­rapy was prescribed based on the patient’s comorbidities (elevated transaminases, decreased left ventricular ejection fraction in history), as well as the proven precapillary contribution to pulmonary hypertension. The key to the favorable course and regression of PAH in this patient was the timely initiation of ART and PAH-specific therapy with continued good medication adherence, as well as regular follow-up.