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Letters |1 December 1997

Prostacyclin for HIV-Associated Pulmonary Hypertension

Hans Stricker, MD; Guido Domenighetti, MD; Giorgio Mombelli, MD

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  • Regional Hospital; CH-6600 Locarno, Switzerland
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TO THE EDITOR:
Primary pulmonary hypertension is a progressive, therapy-resistant illness associated with a median survival of 2.8 years; the mortality rate correlates with measures of right ventricular function [1]. A promising new therapeutic strategy includes long-term intravenous [2] or aerosolized [3] administration of prostacyclin.
Recent reports suggest an increased incidence of pulmonary hypertension, probably unrelated to the degree of immunodeficiency, in HIV-infected persons [4]. We describe two HIV-infected patients with pulmonary hypertension who were treated for 7 months with aerosolized prostacyclin. Both 33-year-old, formerly drug-addicted men were given a diagnosis of pulmonary hypertension after the American College of Chest Physicians published its consensus algorithm [5]. The patients' CD4+ counts ranged from 200 to 400 cells/mm3, and symptoms were dyspnea in New York Heart Association (NYHA) class IV. Catheterization of the right side of the heart confirmed severe pulmonary hypertension, with mean pulmonary artery pressures of 73 and 53 mm Hg, respectively. Epoprostenol (Flolan, Glaxo-Wellcome, United Kingdom) was jet-nebulized with room air and subsequently inhaled (Pari IS-2, Starnberg, Germany; 40% of droplet size <3 microm), starting with a dosage of 2 ng/kg of body weight per minute and increasing by 10-minute increments to a dosage as high as 40 ng/kg per minute.
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Stricker H, Domenighetti G, Mombelli G. Prostacyclin for HIV-Associated Pulmonary Hypertension. Ann Intern Med. ;127:1043. doi: 10.7326/0003-4819-127-11-199712010-00030

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Published: Ann Intern Med. 1997;127(11):1043.

DOI: 10.7326/0003-4819-127-11-199712010-00030

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