Long-term effects of bosentan in patients with HIV-associated pulmonary arterial hypertension

¹ Service de Pneumologie et Réanimation Respiratoire, Université Paris-Sud 11, Centre National de Reference de l'Hypertension Arterielle Pulmonaire, Institut Paris-Sud Cytokines, Hôpital Antoine- Béclère, Clamart, France; and Service de Pneumologie et Réanimation, CHU Larrey, Toulouse, France
² Service de Pneumologie et Réanimation Respiratoire, Université Paris-Sud 11, Centre National de Reference de l'Hypertension Arterielle Pulmonaire, Institut Paris-Sud Cytokines, Hôpital Antoine- Béclère, Clamart, France
³ Service de Pneumologie et Réanimation, CHU Larrey, Toulouse, France

	Abstract

Bosentan has proven 4-month efficacy in patients with human immunodeficiency virus-associated pulmonary arterial hypertension (PAH-HIV). Here, we describe the long-term outcome of unselected PAH-HIV patients treated with first-line bosentan.

Data were analysed for 59 consecutive WHO functional class II-IV PAH-HIV patients treated with first-line bosentan between May 2002 and July 2007. HIV status, 6-minute walk distance and haemodynamics were assessed at baseline, after 4 months, and every 6–12 months thereafter.

After 4 months, 6-minute walk distance increased from 358±98 to 435±89m and pulmonary vascular resistance decreased from 737±328 to 476±302 dyn·s·cm^-5. At last evaluation, 29±15 months, 6-minute walk distance remained stable and pulmonary vascular resistance decreased further to 444±356 dyn·s·cm^-5. Haemodynamics normalised in 10 patients. At their last evaluation, these 10 patients were in WHO functional class I, with a 6-minute walk distance of 532±52m. Overall survival estimates were 93%, 86% and 66% at 1, 2 and 3 years, respectively. Bosentan was safe when combined with highly-active antiretroviral therapy with no negative impact on HIV-infection control.

Our data confirm long-term benefits of bosentan therapy in PAH-HIV patients with improvements in symptoms, 6-minute walk distance and haemodynamics, and with favourable overall survival.