Evolution of the incidence of pulmonary arterial hypertension (PAH) in patients with HIV infection over the past 15 years.

<bold>Rationale:</bold> Pulmonary arterial hypertension (PAH) is a rare but severe complication of HIV infection. In France, it seems to be a decline in the incidence and severity at diagnosis of PAH in HIV patients since 2007. <bold>Objectives:</bold> Describe the evolution of PAH incidence in the HIV population (PAH-HIV) since 2007, in parallel with the evolution of HIV and PAH epidemiology in France. <bold>Methods:</bold> Observational, restrospective study based on the French pulmonary hypertension registry. <bold>Results:</bold> Between 2007 and 2022, 251 PAH-HIV patients were registered in the French PH registry. Right heart catheterization showed PAH in all patients. The incidence of PAH-HIV has decreased since 2007 (6,1% in 2007 vs. 1.7% in 2022), while the incidence of PAH and HIV has remained stable. The phenotype of PAH-HIV patients is evolving at diagnosis as patients diagnosed since 2015 are older, more frequently smokers, with a higher BMI, and have less hepatic comorbidities. Hemodynamic appeared to be similar in patients diagnosed before and after 2015 as well as survival but significantly more patients have been treated with dual therapy at diagnosis since 2015. We observed a significant hemodynamic response in the 77% patients who were reassessed. <bold>Conclusion:</bold> Incidence of PAH-HIV has been declining since 2007, while the incidence of PAH and HIV remains stable. Phenotype of PAH-HIV patients changes. Earlier introduction of antiretroviral treatment regardless of CD count since 2015 could explain the lower incidence of PAH-HIV, but does not have any impact on the hemodynamic severity and survival.