Should all patients with pulmonary hypertension undergo HIV serologic testing?

To evaluate the yield of screening patients with pulmonary hypertension (PH) for human immunodeficiency virus (HIV) infection.

We retrospectively reviewed the records of consecutive patients with PH seen at our institution from July 1992 to November 2008. We assessed HIV risk factors and history of HIV. We estimated the proportion of patients who tested positive for HIV.

We identified 445 patients with PH who had serologic testing for HIV antibody. The mean age was 63 years, and 66% were women. Of these patients, 224 (50%) were in World Health Organization diagnostic group I, pulmonary arterial hypertension (PAH). Only 1 patient (0.2%; 95% confidence interval, 0.0%-1.2%) was positive for HIV, and this was the only patient who had a known history of HIV infection. Ten other patients (2.2%) had risk factors for HIV infection but had negative serologic results. The patient who tested positive for HIV had PAH, yielding an estimated prevalence of positive HIV testing in that subgroup of 0.4% (95% confidence interval, 0.0%-2.5%); 6 other patients with PAH (2.7%) had risk factors for HIV but negative serology.

To our knowledge, this is the first study examining the yield of screening patients with PH for HIV using serologic testing. Of the 445 patients tested, only 1 patient was positive for HIV. This patient was known to have risk factors for and exposure to HIV. Patients with PAH should be assessed for risk factors for HIV before testing for HIV in low-risk populations.