Principles of agent selection for PAH-directed therapy in patients with HIV

PAH: pulmonary arterial hypertension; HIV: human immune deficiency virus; NYHA: New York Heart Association; PDE5: phosphodiesterase type 5; ART: antiretroviral therapy.
* The principles of agent selection are similar to those in the non-HIV-infected PAH population with the exception that calcium channel blockers be avoided. All patients should be managed by PAH and HIV experts who weigh the risks of drug interactions and benefits of a specific therapy.
¶ No ART dose adjustments are needed for regimens that contain prostacyclin agonists (eg, epoprostenol, trepostinol, iloprost, selexipag) or the endothelin receptor atagonist, ambrisentan.
◊ When modifying an ART regimen it is important to ensure the potency of the regimen and specific antiretroviral agents are preferred for patients with certain comorbid conditions (eg, chronic hepatitis B). Please refer to the topics that discusses switching regimens within UpToDate.