CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 7, August 2012
e6
AFRICA
associated with HIV, there is no consensus on the management of
PAH in pregancy.
4,6
Although highly active antiretroviral therapy
has resulted in modest improvement in pulmonary pressures
in some series,
7
HIV-associated PAH, as with other forms of
PAH, generally requires treatment with medications targeting
the pulmonary vasculature, such as bosentan, prastacyclin and
sildenafil.
4
However, in pregnancy, only prostanoid therapy is
recommended, while endothelin receptor agonists are contra-
indicated because of teratogenic effects.
6
Several case reports
have described improved maternal and foetal outcomes, likely
due to the advent of the new advanced pulmonary hypertension
therapies, earlier diagnosis of PAH, and the adoption of a
multidisciplinary approach to treatment.
6
Conclusion
There are at least three major implications of this report. First,
it raises the question of antenatal screening of HIV-positive
patients for PAH using echocardiography and new biomarkers of
myocardial dysfunction, such as serum brain natriuretic peptide
(BNP) level,
8
given the association of PAH with HIV infection.
Second, the diagnosis of PAH ought to be considered in all
pregnant HIV-positive patients with shortness of breath, signs of
right heart failure and clinically normal lungs. Early detection of
PAH associated with HIV in pregnancy by echocardiography may
lead to the institution of life-saving therapy.
6
Finally, research is
needed to establish the clinical epidemiology and appropriate
management of PAH in pregnant patients living with HIV.
2
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