Pulmonary hypertension and human immunodeficiency virus infection: epidemiology, pathogenesis, and clinical approach  S. Cicalini, S. Almodovar, E. Grilli, S. Flores  Clinical Microbiology and Infection  Volume 17, Issue 1, Pages 25-33 (January 2011) DOI: 10.1111/j.1469-0691.2010.03286.x Copyright © 2011 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1.1 Human immunodeficiency virus-associated pulmonary hypertension diagnostic approach. PH, pulmonary hypertension; ECG, electrocardiogram; TTE, transthoracic echocardiography; ABG, arterial blood gas; CT, computed tomography; COPD, chronic obstructive pulmonary disease; PPH, portopulmonary hypertension; PAH, pulmonary arterial hypertension; 6MWD, 6-minute walking distance. Clinical Microbiology and Infection 2011 17, 25-33DOI: (10.1111/j.1469-0691.2010.03286.x) Copyright © 2011 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 2 Pathogenetic views of human immunodeficiency virus (HIV)-associated pulmonary arterial hypertension (HIV-PAH). The presence of HIV in the pulmonary vasculature may trigger several aberrant responses at the subcellular level that are translated to the macrovasculature and microvasculature. Established risk factors for HIV-PAH are shown in circles outlined in red; additional factors that merit consideration are shown in circles outlined in grey. For example, cardiovascular complications have been ascribed to iatrogenic metabolic effects of prolonged exposure to protease inhibitors in the antiretroviral regimens. Considering that, with the advent of antiretrovirals, HIV-infected patients live longer, antiretroviral drugs add to the complex interplay between the virus and the cells, as older HIV-infected patients may experience the effects of accelerated vascular ageing and distress. Also, known comorbidities in HIV infection (e.g. other viral infections, hypertension and diabetes) might exacerbate the insults to the pulmonary vasculature. Each one of the aspects presented in this figure offers a niche to search for biomarkers of HIV-PAH, to expedite the screening and diagnosis. EC, endothelial cell. Clinical Microbiology and Infection 2011 17, 25-33DOI: (10.1111/j.1469-0691.2010.03286.x) Copyright © 2011 European Society of Clinical Infectious Diseases Terms and Conditions