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Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension

¹ Dept of Respiratory and Intensive Care Medicine, Université Paris-Sud 11, National Reference Centre for Pulmonary Arterial Hypertension, Institut Paris-Sud Cytokines, Hôpital Antoine Béclère, Clamart, ² Dept of Respiratory and Intensive Care Medicine, Centre Hospitalier Universitaire Larrey, Toulouse, France

CORRESPONDENCE: O. Sitbon, Service de Pneumologie, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart, France. Fax: 33 146303824. E-mail: olivier.sitbon{at}abc.aphp.fr

Keywords: Bosentan, endothelin, HIV, hypertension, pulmonary

Received: June 23, 2008
Accepted August 25, 2008

Bosentan has proven 4-month efficacy in patients with HIV-associated pulmonary arterial hypertension (PAH-HIV). Herein, the long-term outcome of unselected PAH-HIV patients treated with first-line bosentan is described.

Data for 59 consecutive World Health Organization (WHO) functional class II–IV PAH-HIV patients treated with first-line bosentan between May 2002 and July 2007 were analysed. HIV status, 6-min walk distance and haemodynamics were assessed at baseline, after 4 months and every 6–12 months thereafter.

After 4 months, 6-min walk distance increased from 358±98 to 435±89 m and pulmonary vascular resistance decreased from 737±328 to 476±302 dyn·s·cm^–5. At the final evaluation (29±15 months), 6-min walk distance remained stable and pulmonary vascular resistance decreased further to 444±356 dyn·s·cm^–5. Haemodynamics normalised in 10 patients. At their last evaluation, these 10 patients were in WHO functional class I, with a 6-min walk distance of 532±52 m. Overall survival estimates were 93, 86 and 66% at 1, 2 and 3 yrs, respectively. Bosentan was safe when combined with highly active antiretroviral therapy, with no negative impact on HIV infection control.

The present data confirm the long-term benefits of bosentan therapy in HIV-associated pulmonary arterial hypertension patients with improvements in symptoms, 6-min walk distance and haemodynamics, and with favourable overall survival.

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