As antiretroviral
therapy has improved life expectancy in human immunodeficiency virus (
HIV) infection, the life-limiting complication of HIV-related
pulmonary hypertension has come into focus. Inhalation of the stable
prostacyclin analogue
iloprost is an effective treatment for various forms of precapillary
pulmonary hypertension. The main objective of the present study was to evaluate the safety and efficacy of inhaled
iloprost in HIV-related
pulmonary hypertension. In eight patients with severe
pulmonary hypertension related to
HIV infection, right heart and femoral artery catheterisation were performed. The acute effect of
oxygen, inhaled
nitric oxide and aerosolised
iloprost was investigated. Four patients underwent long-term treatment with inhaled
iloprost. The rank order of pulmonary vasodilatory potency was
iloprost>NO>O2, with a maximum reduction (mean +/- SEM) in pulmonary vascular resistance of 30.6 +/- 3.1% (p < 0.001), 5.9 +/- 3.9% and -0.6 +/- 3.9%, respectively. Concomitantly, inhaled
iloprost significantly increased the cardiac index and central venous oxygen saturation. Chronic treatment with inhaled
iloprost tended to improve the 6 min walking distance and decreased pulmonary vascular resistance in all patients (although not significantly). No serious adverse events and no major interactions with the ongoing antiretroviral
therapy were noted. In conclusion, inhaled
iloprost is a potent pulmonary
vasodilator in human immune deficiency virus-related
pulmonary hypertension. Future studies are warranted to confirm the encouraging long-term beneficial results observed in the present limited number of patients.