CHEST Guidelines-Severe-Pulmonary-Arterial-Hypertension-in Pat

Severe-Pulmonary-Arterial-Hypertension-in Pat

Pdf Summary

The article discusses the potential link between hepatitis C treatment using sofosbuvir and the onset or exacerbation of severe pulmonary arterial hypertension (PAH). This is reported for the first time through three case studies of patients treated with sofosbuvir-based regimens for hepatitis C virus (HCV) infection. These patients, who had PAH-associated comorbidities like HIV coinfection and portal hypertension, developed severe PAH symptoms shortly after completing their antiviral therapies.<br /><br />The cases highlighted include patients who either newly developed PAH or experienced a worsening of pre-existing PAH following sofosbuvir treatment. One patient had a previously stable PAH and another displayed preclinical indicators of PAH before treatment, suggesting an exacerbation due to the therapy. In these cases, symptoms such as worsening dyspnea and syncope led to a diagnosis of severe PAH with hemodynamic instability.<br /><br />The authors suggest that the suppression of HCV replication due to sofosbuvir might lead to decreased levels of vasodilatory inflammatory mediators, exacerbating PAH. While the safety of sofosbuvir has been confirmed in previous studies, the new onset or exacerbation of PAH observed in these cases raises concerns about potential cardiovascular risks associated with sofosbuvir-based treatments in patients with pre-existing or latent PAH.<br /><br />The article calls for careful cardiological monitoring for patients with PAH risk factors during DAA therapy and highlights the need for more research into the relationship between hepatitis C treatment and PAH. It also recommends that healthcare providers report any suspected cases of DAA-induced or exacerbated PAH to appropriate surveillance programs to better understand and manage this potential adverse event.

Keywords

hepatitis C

sofosbuvir

pulmonary arterial hypertension

PAH

case studies

HCV infection

HIV coinfection

portal hypertension

cardiovascular risks

DAA therapy