{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:17:25Z","timestamp":1783574245110,"version":"3.55.0"},"reference-count":60,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":79,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>HIV\u2010associated pulmonary arterial hypertension (HIV\u2010PAH) remains one of the most consequential cardiopulmonary complications in people living with HIV (PLWH), persisting despite expanded antiretroviral therapy (ART) coverage. Although contemporary hemodynamic criteria define pulmonary hypertension (PH) as mean pulmonary arterial pressure (mPAP)\u2009&gt;\u200920\u2009mmHg and pulmonary arterial hypertension (PAH) as pre\u2010capillary physiology confirmed by right heart catheterization (mPAP &gt;\u200920\u2009mmHg, pulmonary arterial wedge pressure \u2264\u200915\u2009mmHg, pulmonary vascular resistance &gt;\u20092 Wood units), global epidemiologic certainty remains uneven. In high\u2010income settings, prospective screening paradigms incorporating catheter confirmation estimate HIV\u2010PAH prevalence at approximately 0.5%, exemplified by the multicenter French study reporting 0.46%. In contrast, in sub\u2010Saharan Africa\u2014home to more than 26 million PLWH\u2014the population prevalence of catheter\u2010confirmed HIV\u2010PAH remains undefined, with echocardiography\u2010based studies in symptomatic cohorts reporting substantially higher rates of elevated pulmonary pressures. Mechanistically, HIV\u2010PAH is best conceptualized as a multi\u2010hit pulmonary vasculopathy driven by viral proteins (Tat, Nef, gp120), chronic immune activation, endothelial dysfunction, oxidative stress, dysregulated endothelin signaling, and growth\u2010factor pathways, with amplification by endemic co\u2010factors and host susceptibility. Clinically, HIV\u2010PAH is a \u201cclinically nonspecific phenotype\u201d, frequently obscured by tuberculosis\u2010related lung disease, anemia, left heart disease, and other causes of dyspnea in resource\u2010limited settings. Early recognition is critical because prognosis depends on preservation of right ventricular function. A practical, resource\u2010appropriate strategy is required: heightened clinical suspicion, echocardiography\u2010anchored detection, systematic exclusion of alternative PH etiologies, rational biomarker use, and referral pathways to right heart catheterization where feasible. ART optimization is necessary but insufficient; PAH\u2010targeted therapies can improve functional and hemodynamic outcomes, though HIV\u2010specific randomized evidence remains limited. Implementation science and mechanism\u2010informed research in endemic regions are urgently needed to close the diagnostic and therapeutic gap.<\/jats:p>","DOI":"10.1002\/pul2.70341","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:49:30Z","timestamp":1781858970000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV\u2010Associated Pulmonary Arterial Hypertension in Resource\u2010Limited Settings: A \u201cForgotten\u201d Diagnosis, a Great Imitator, and a Multi\u2010Hit Pulmonary Vasculopathy"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-5477","authenticated-orcid":false,"given":"Emmanuel","family":"Eroume A Egom","sequence":"first","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"},{"name":"Institut du Savoir Montfort (ISM) Ottawa Ontario Canada"},{"name":"Heart and Vascular Institute, Department of Medicine Hartford HealthCare Hartford Connecticut USA"},{"name":"Harmony Health Physical and Spiritual Wellness Center\/Harmony Care and Heaven Foundation\u2010 Fondation CIEL Hartford Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mfopa","family":"Adamou","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahima","family":"Djould\u00e9","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Njimona","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mountchissi","family":"C\u00e9lestin","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9695-7645","authenticated-orcid":false,"given":"Lum Abenwi","family":"Ambe","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medou Mba","family":"Fabrice","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Moustapha","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Kamgang","sequence":"additional","affiliation":[{"name":"Laboratory of Human Metabolism and Non\u2010Communicable Diseases Institute of Medical Research Medicinal Plants Studies (IMPM) Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_16_2_1","volume-title":"HIV and AIDS [Internet]","author":"Organization W. 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