HIV status and survival of patients with pulmonary hypertension due to left heart disease: the Pan African Pulmonary Hypertension Cohort

Abstract Little is known about pulmonary hypertension in left heart disease (PH-LHD) in sub-Saharan Africa. We used multivariate logistic and cox-hazard proportional regression models to investigate factors associated with increased right ventricular systolic pressure (RVSP) and the impact of real-world HIV status scenarios on six-month survival rate in the Pan African Pulmonary Hypertension Cohort (PAPUCO) study, a prospective cohort in four African countries. Upon presentation, exposure to biomass fuel smoke (aOR, 95%CI: 3.07, 1.02-9.28), moderate to severe NYHA/FC III/IV (aOR, 95%CI: 4.18, 1.01-17.38) and unknown HIV status (aOR, 95%CI: 2.73, 0.96-7.73) predicted moderate to severe RVSP. After six months, HIV infection, moderate to severe NYHA/FC and alcohol consumption were associated with reduced survival odds. After accounting for HIV infection, each additional increase in RVSP (1 mmHg) and interventricular septal thickness (1 mm) increased the likelihood of dying from PH-LHD by 8% (aHR, 95%CI: 1.08, 1.02-1.13) and 20% (aHR, 95%CI: 1.2, 1.00-1.43), respectively. However, for each additional unit of BMI, the hazard of dying from PH-LHD was reduced by 23%. (aHR, 95%CI: 0.77, 0.59-1.00). We provide factors that are significantly associated with poor survival in PH-LHD patients, some of which are easily assessable and modifiable in resource-constrained settings.