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An association between HIV infection and pulmonary arterial
hypertension was first reported in 1991.
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► In population studies in which ECHO was used to estimate PA pressure, the incidence
of PH ~0.5 % among patients with HIV infection
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► a rate 6 to 12 times as high as in the general population.
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► prevalence has not changed since 1991 despite the introduction of HAART
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► In population studies in which ECHO was used to estimate PA pressure, the incidence
of PH ~0.5 % among patients with HIV infection
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The occurrence of pulmonary arterial hypertension is independent of the CD4 cell
count, but it appears to be related to the duration of HIV infection.
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Many of these patients also have foreign-body emboli as a result of the use of
intravenous drugs or portal hypertension due to a concomitant infection with
hepatitis B or C.
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Still under discussion if HIV does directly infect endothelial cells, the mechanism
of pulmonary hypertension in HIV infection is unclear.
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Postulated mechanism of HIV proteins like Envelope glycoprotein-120(Env),
transactivator of transcription (Tat) and HIV negative factor (Nef).
Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...
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