The use of highly active antiretroviral therapy (HAART) has increased the life expectancy of HIV-infected patients. With prolonged survival and improved control of infectious susceptibility, vascular complications have emerged as a significant source of morbidity and mortality in HIV-infected patients [1]. These vascular complications, affecting >10% of those with HIV infections, include myocardial and pericardial tumours, cardiomyopathy, selleck products peripheral vasculitides, ischaemic heart disease and pulmonary hypertension

[1]. Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary arterial pressures and pulmonary vascular resistance (PVR) leading to right ventricular failure and premature death [2]. The pathological abnormalities in the small pulmonary arteries are characterized by intimal, medial and adventitial proliferation and hypertrophy, endothelial dysfunction and the development of plexogenic lesions [2]. PAH can exist in idiopathic and familial forms but can also be associated with other causes including connective tissue disorders, drugs, portal hypertension,

pulmonary veno-occlusive disease, congenital right to left shunts and HIV infection [2]. Although HIV-related PAH is clinically and histologically similar to idiopathic pulmonary arterial hypertension (IPAH), the pathobiological mechanism leading to the development of PAH in patients with HIV infection remains unclear [3], as it does in IPAH. HIV-related PAH is a rare entity. The prevalence HSP targets was estimated to be approximately 0.5% in HIV-infected patients in a study by Opravil et al. [4] in 1997, before the HAART era. This rate is 25-fold higher than the prevalence of PAH in the general population [5]. According to a more recent study by Sitbon et al. [6] in 2008, the prevalence has remained at 0.5% even in the modern era of HIV therapy, suggesting that HAART has not made a dramatic impact on the prevention of HIV-related PAH. Most of the literature

on HIV-related PAH is based on case reports and small cohort studies. Since the last analytical summary of these case reports in 2000 by Mehta et al. [7] and the last systematic review by Pellicelli et al. [8], there have selleck screening library been an additional 60 cases reported in the literature and several additional cohort studies. Furthermore, the majority of these new cases have been reported in the modern age of HAART therapy. The purpose of our study was to synthesize the published data on HIV-related PAH by performing a systematic review of the current literature. We decided a priori to examine the published evidence on HIV-related PAH. Searches were conducted on MEDLINE (inclusive as of March 2009); EMBASE (inclusive as of March 2009), the Cochrane collaboration and the Cochrane Register of controlled trials for relevant trials.