BRIEF REPORT Echocardiographic screening for pulmonary arterial hypertension in HIV-positive patients H. ten Freyhaus • D. Vogel • C. Lehmann • T. Ku ¨ mmerle • C. Wyen • G. Fa ¨tkenheuer • S. Rosenkranz Received: 11 January 2014 / Accepted: 28 February 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Human immunodeficiency virus (HIV) infec- tion is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiogra- phy, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed. Keywords HIV Á ART Á Pulmonary hypertension Á Left ventricular diastolic dysfunction Á Echocardiography Introduction Pulmonary hypertension (PH) is characterized by a marked and sustained elevation of pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) [1]. Pul- monary arterial hypertension (PAH) is distinguished from other more prevalent forms of PH that may occur sec- ondary to various underlying causes, including left heart disease, chronic respiratory disorders, and chronic throm- boembolic disease. Without sufficient treatment, PAH harbors a poor prognosis, and right ventricular failure represents the common cause of death. Data from the US registry that were collected in the 1980s—when there was no efficient treatment available—showed that the median survival was limited to only 2.8 years [2]. Since then, a number of drugs have been approved for the treatment of PAH, and this has led to a marked improvement of out- come and quality of life. While echocardiography repre- sents an important diagnostic tool in the setting of PH, definitive diagnosis and classification require right heart catheterization (RHC) before the initiation of targeted therapy. There is no specific sign in patients with PH. While the most common symptom suggesting PH is dyspnea on exertion, other signs such as angina, syncope, peripheral edema, fatigue, and abdominal distension may also be present. The lack of specific symptoms often leads to a delay of diagnosis, so that approximately 75–90 % of patients are diagnosed in the World Health Organization functional class (WHO-FC) III–IV. As the WHO-FC is a strong predictor of survival in PAH, the early diagnosis of PH, especially in patients at risk, is highly warranted. The clinical classification of PH was last updated at the Fifth World Symposium on Pulmonary Hypertension in Nice, France, February/March 2013, and defines five sub- groups of the disease [3]. Human immunodeficiency virus (HIV) infection is a risk factor for PAH and HIV-associ- ated PAH is classified as part of group 1. Since 1996, combination antiretroviral therapy (ART) has been com- mon for the treatment of HIV infection and has led to a dramatic improvement of survival and morbidity. How- ever, the prevalence of PAH is approximately 1,000-fold higher in HIV-infected individuals as compared to the H. ten Freyhaus (&) Á D. Vogel Á S. Rosenkranz Klinik III fu ¨r Innere Medizin, Herzzentrum der Universita ¨t zu Ko ¨ln, Kerpener Strasse 62, 50937 Cologne, Germany e-mail: henrik.ten-freyhaus@uk-koeln.de C. Lehmann Á T. Ku ¨mmerle Á C. Wyen Á G. Fa ¨tkenheuer Klinik I fu ¨r Innere Medizin, Uniklinik Ko ¨ln, Kerpener Strasse 62, 50937 Cologne, Germany G. Fa ¨tkenheuer German Centre for Infection Research (DZIF), partner site Bonn–Cologne, Braunschweig, Germany 123 Infection DOI 10.1007/s15010-014-0610-8