Infectious Diseases and Pulmonary Arterial Hypertension: A Review.

BACKGROUND

Pulmonary arterial hypertension (PAH) is a progressive disease characterised by increased pulmonary vascular resistance, leading to right heart failure and premature death. Although classically linked to idiopathic and autoimmune disorders, infectious diseases are increasingly recognised as contributors to PAH pathogenesis.

METHOD: This scoping review mapped current evidence on associations between infectious diseases and PAH, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, and Web of Science were searched for studies addressing epidemiology, mechanisms and clinical implications.

RESULTS

Evidence shows robust associations for human immunodeficiency virus and schistosomiasis (Tier 1); hepatitis C virus and hepatitis B virus (Tier 2); and coronavirus disease 2019 (Tier 3). Common mechanisms include chronic inflammation, endothelial dysfunction and vascular remodelling.

CONCLUSIONS

Infection-associated PAH remains underrecognised in diagnostic frameworks and clinical practice, particularly in low- and middle-income countries where these infections are endemic. Integrating PAH screening and management into existing infectious disease programs could improve early diagnosis and outcomes. Addressing this neglected interface is crucial to reducing morbidity and advancing health equity for affected populations worldwide.