Abstract
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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