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Eur Respir J 2005; 26:969-972
Copyright ©ERS Journals Ltd 2005

Reversibility of pulmonary arterial hypertension in HIV/HHV8-associated Castleman's disease

D. Montani1, L. Achouh1, A. G. Marcelin2, J-P. Viard3, O. Hermine4, D. Canioni5, O. Sitbon1, G. Simonneau1 and M. Humbert1

1 Centre des Maladies Vasculaires Pulmonaires, UPRES EA2705, Service de Pneumologie et Réanimation respiratoire, Hôpital Antoine-Béclère, Université Paris-Sud, and 2 Service de Virologie, Hôpital Pitié-Salpétrière, and 3 Service des Maladies Infectieuses, and 4 Service d'Hématologie, and 5 Service d'Anatomie Pathologique, Groupe hospitalier Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.

CORRESPONDENCE: M. Humbert, Centre des Maladies Vasculaires Pulmonaires, UPRES EA 2705, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, 157 rue de la Porte de Trivaux, 92140 Clamart, France. Fax: 33 146303824. E-mail: marc.humbert{at}abc.ap-hop-paris.fr

Keywords: Castleman's disease, HIV, human herpes virus 8, pulmonary arterial hypertension

Received: November 23, 2004
Accepted April 26, 2005

The present study describes a case of pulmonary arterial hypertension (PAH) associated with multicentric Castleman's disease in a patient infected with HIV type 1 and human herpes virus 8.

Therapy included highly active antiretroviral therapy, warfarin, diuretics, continuous i.v. epoprostenol and 12-monthly pulses of cyclophosphamide.

The patient's condition improved dramatically with complete reversibility of PAH, allowing weaning of continuous i.v. epoprostenol therapy. After 5 yrs, both Castleman's disease and PAH have not relapsed. This supports the hypothesis that control of inflammation and retroviral replication may be of interest in the context of PAH, complicating the course of an inflammatory condition associated with viral infection.

In conclusion, further studies should help in characterising the best candidates for anti-inflammatory treatment in the setting of pulmonary arterial hypertension.




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