Publications

Antiretroviral therapy has greatly increased longevity for individuals with human immunodeficiency virus (HIV) infection. About 0.5% of patients with HIV infection develop moderate to severe pulmonary arterial hypertension, which is several thousand times higher than the incidence of idiopathic pulmonary arterial hypertension. As more than 30 million individuals are chronically infected, HIV infection could soon become one of the most common causes of pulmonary arterial hypertension worldwide. Pulmonary arterial hypertension is a relentlessly progressive disease leading to right heart failure and death. In this article the available data on epidemiology, hemodynamics, mechanisms, and therapeutic strategies for HIV-associated pulmonary arterial hypertension are reviewed.

In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors-including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities-may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.