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Drug abuse and HIV-related pulmonary hypertension

double hit injury

Harter, Zachery J.a; Agarwal, Stutia; Dalvi, Pranjalia; Voelkel, Norbert F.b; Dhillon, Navneet K.a

doi: 10.1097/QAD.0000000000002030

Improved survival among HIV-1-infected individuals with the advent of antiretroviral therapy has clearly led to a greater prevalence of noninfectious complications. One of the most devastating sequelae in these individuals is the development of pulmonary arterial hypertension (PAH). Various epidemiological studies suggest worse survival of HIV-PAH patients when compared with other forms of PAH. Given that only a subset and not all HIV-infected individuals develop HIV-PAH, it is suggested that an additional second-hit of genetic or environmental trigger is needed for the development of PAH. In this context, it has been well documented that HIV patients who abuse illicit drugs such as stimulants, opioids, and the like, are more susceptible to develop PAH. In this review, we highlight the studies that support the significance of a double hit of HIV and drug abuse in the incidence of PAH and focus on the research that has been undertaken to unravel the pathobiology and vascular remodeling mechanisms underlying the deleterious synergy between HIV infection and drugs of abuse in orchestrating the development of PAH.

aDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA

bVrije University Medical Center, Amsterdam, Netherlands.

Correspondence to Navneet K. Dhillon, PhD, Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. Tel: +1 913 945 6018; e-mail:

Received 11 May, 2018

Accepted 27 July, 2018

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