***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background — There is a paucity of data to describe the clinical characteristics of  heart failure ( HF ) in urban African communities in epidemiological transition . Methods and Results — Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto , South Africa . Of 1960 cases of HF and related cardiomyopathies in 2006 , we prospect ively collected detailed demographic and clinical data from all 844 de novo presentations ( 43 % ) . Mean age was 55±16 years , and women ( 479 [ 57 % ] ) and black Africans ( 739 [ 88 % ] ) predominated . Most ( 761 [ 90 % ] ) had ≥1 cardiovascular risk . Mean left ventricular ejection fraction was 45±18 % . Overall , 180 patients ( 23 % ) had isolated diastolic dysfunction , 234 ( 28 % ) tricuspid regurgitation , 121 ( 14 % ) isolated right HF , and 100 ( 12 % ) mitral regurgitation . The most common diagnoses were hypertensive HF ( 281 [ 33 % ] ) , idiopathic dilated cardiomyopathy ( 237 [ 28 % ] ) , and , surprisingly , right HF ( 225 [ 27 % ] ) . Black Africans had less ischemic cardiomyopathy ( adjusted odds ratio , 0.12 ; 95 % CI , 0.07 to 0.20 ) but more idiopathic and other causes of cardiomyopathy ( adjusted odds ratio , 4.80 ; 95 % CI , 2.57 to 8.93 ) . Concurrent renal dysfunction , anemia , and atrial fibrillation were found in 172 ( 25 % ) , 72 ( 10 % ) , and 53 ( 6.3 % ) cases , respectively . Conclusions — These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa . In addition to tackling antecedent hypertension , a predominance of young women and a large component of right HF predicate the development of tailored therapeutic strategies OBJECTIVE To characterize mortality in persons diagnosed with primary pulmonary hypertension and to investigate factors associated with survival . DESIGN Registry with prospect i ve follow-up . SETTING Thirty-two clinical centers in the United States participating in the Patient Registry for the Characterization of Primary Pulmonary Hypertension supported by the National Heart , Lung , and Blood Institute . PATIENTS Patients ( 194 ) diagnosed at clinical centers between 1 July 1981 and 31 December 1985 and followed through 8 August 1988 . MEASUREMENTS At diagnosis , measurements of hemodynamic variables , pulmonary function , and gas exchange variables were taken in addition to information on demographic variables , medical history , and life-style . Patients were followed for survival at 6-month intervals . MAIN RESULTS The estimated median survival of these patients was 2.8 years ( 95 % Cl , 1.9 to 3.7 years ) . Estimated single-year survival rates were as follows : at 1 year , 68 % ( Cl , 61 % to 75 % ) ; at 3 years , 48 % ( Cl , 41 % to 55 % ) ; and at 5 years , 34 % ( Cl , 24 % to 44 % ) . Variables associated with poor survival included a New York Heart Association ( NYHA ) functional class of III or IV , presence of Raynaud phenomenon , elevated mean right atrial pressure , elevated mean pulmonary artery pressure , decreased cardiac index , and decreased diffusing capacity for carbon monoxide ( DLCO ) . Drug therapy at entry or discharge was not associated with survival duration . CONCLUSIONS Mortality was most closely associated with right ventricular hemodynamic function and can be characterized by means of an equation using three variables : mean pulmonary artery pressure , mean right atrial pressure , and cardiac index . Such an equation , once vali date d prospect ively , could be used as an adjunct in planning treatment strategies and allocating medical re sources BACKGROUND Epidemiology , aetiology , management and outcome data for various forms of pulmonary hypertension ( PH ) in Africa are scarce . METHODS A prospect i ve , multinational cohort registry of 220 consecutive patients ( 97 % of African descent ) from 9 specialist centres in 4 African countries . The antecedents , characteristics and management of newly diagnosed PH plus 6-month survival were studied . RESULTS There were 209 adults ( median age 48years [ IQR 35 , 64 ] ) and 11 children ( age range 1 to 17years ) . Most adults had advanced disease - 66 % WHO Functional Class III-IV , median 6-minute walk test distance of 252 m ( IQR 120 , 350 ) and median right ventricular systolic pressure 58mmHg ( IQR 49 , 74 ) . Adults comprised 16 % pulmonary arterial hypertension , 69 % PH due to left heart disease , 11 % PH due to lung disease and /or hypoxia , 2 % chronic thromboembolic pulmonary hypertension , and 2 % PH with unclear multifactorial mechanism . At 6-months , 21 % of adults with follow-up data had died . On an adjusted basis ( independent of sub-groups ) mortality was associated with increasing functional impairment ( p=0.021 overall - WHO Class IV versus I , OR 1.68 [ 95 % CI 0.13 , 4.36 ] ) and presence of combined right atrial and ventricular hypertrophy ( 46 % - OR 2.88 , 95 % CI 1.45 , 5.72 ) . Children commonly presented with dyspnoea , fatigue , cough , and palpitations with six and three children , respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease . CONCLUSIONS These data provide new insights into PH from an African perspective , with clear opportunities to improve its prevention , treatment and outcomes . TRIAL REGISTRATION Clinical Trials.gov ( NCT02265887 ) AIMS The contemporary impact of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome ( AIDS ) epidemic on heart disease in South Africa ( > 5 million people affected ) is unknown . The Heart of Soweto Study provides a unique opportunity to identify the contribution of cardiac manifestations of this epidemic to de novo presentations of heart disease in an urban African community in epidemiological transition . METHODS AND RESULTS Chris Hani Baragwanath Hospital services the > 1 million people living in Soweto , South Africa . A prospect i ve , clinical registry captured data from all de novo cases of heart disease presenting to the Cardiology Unit during 2006 - 08 . We describe all cases where HIV/AIDS was concurrently diagnosed . Overall , 518 of 5328 de novo cases of heart disease were identified as HIV-positive ( 9.7 % ) with 54 % of these prescribed highly active anti-retroviral therapies on presentation . Women ( 62 % ) and Africans ( 97 % ) predominated with women being significantly younger than men 38 ± 13 vs. 42 ± 13 years ( P = 0.002 ) . The most common primary diagnosis attributable to HIV/AIDS was HIV-related cardiomyopathy ( 196 cases , 38 % ) ; being prescribed  more anti-retroviral therapy  ( 127/196 vs. 147/322 ; odds ratio 2.85 , 95 % confidence interval 1.81 - 3.88 ) with higher viral loads [ median 110 000 ( inter-quartile range 26 000 - 510 000 ) vs. 19 000 ( 3200 - 87 000 ) ; P = 0.018 ] and a lower CD4 count [ median 180 ( 71 - 315 ) vs. 211 ( 96 - 391 ) ; P = 0.019 ] than the rest . An additional 128 cases ( 25 % ) were diagnosed with pericarditis/pericardial effusion with a range of other concurrent diagnoses evident , including 42 cases ( 8.1 % ) of HIV-related pulmonary arterial hypertension . Only 14 of all 581 cases of coronary artery disease ( CAD ) ( 2.4 % , mean age 41 ± 13 years ) were confirmed HIV-positive . CONCLUSION Cardiac manifestations of HIV/AIDS identified within this cohort were relatively infrequent . While HIV-related cardiomyopathy and pericardial disease remain important targets for early detection and treatment in this setting , HIV-related cases of CAD remain at historically low levels Introduction Recently published large r and omized controlled trials , START , TEMPRANO and HPTN 052 show the clinical benefit of early initiation of antiretroviral treatment ( ART ) in HIV-infected persons and in reducing HIV transmission . The trials influenced the World Health Organization ( WHO ) decision to issue up date d recommendations to prescribe ART to all individuals living with HIV , irrespective of age and CD4 cell count . Discussion It is clear that the new 2015 WHO recommendations if followed , will change the face of the HIV epidemic and probably curb its burden over time . Implementation however , requires that health systems , especially those in low and middle-income setting s , be ready to face this challenge on a large scale . HIV prevention and treatment are easy in theory yet hard in practice . The new WHO guidelines for initiation of ART regardless of CD4 cell count will lead to upfront increases in the costs of healthcare delivery as the goal is to treat all those now newly eligible for ART . Around 22 million people living with HIV qualify and will therefore require ART . Related challenges immediately follow : firstly , that everyone must be tested for HIV ; secondly , that anyone who has had an HIV test should know their result and underst and its significance ; and , thirdly , that every person identified as HIV-positive should receive and remain on ART . The emergence of HIV drug resistant strains when treatment is started at higher CD4 cell count thresholds is a further concern as persons on HIV treatment for longer periods of time are at increased risk of intermittent medication adherence . Conclusions The new WHO recommendations for ART are welcome , but lacking as they fail to consider meaningful solutions to the challenges inherent to implementation . They fail to incorporate actual strategies on how to disseminate and adopt these far-reaching guidelines , especially in sub-Saharan Africa , an area with weak healthcare infrastructures . Well- design ed , high- quality research is needed to assess the feasibility , safety , acceptability , impact , and cost of innovations such as the universal voluntary testing and immediate treatment approaches , and broad consultation must address community , human rights , ethical , and political concerns RATIONALE The prevalence of HIV-associated pulmonary arterial hypertension ( PAH ) has not been evaluated since introduction of combined , highly active antiretroviral treatments . OBJECTIVES To establish the current prevalence of PAH in a large HIV-positive population . METHODS Prospect i ve study conducted in 7,648 consecutive HIV-positive adults in 14 HIV clinics in France . PAH was identified through screening with a predefined algorithm . Patients with dyspnea unexplained by other causes underwent transthoracic Doppler echocardiography . PAH was suspected if peak velocity of tricuspid regurgitation was greater than 2.5 m/second and was confirmed by right heart catheterization . MEASUREMENTS AND MAIN RESULTS PAH was diagnosed if mean pulmonary arterial pressure at rest was 25 mm Hg or greater ( with pulmonary capillary wedge pressure < or = 15 mm Hg ) or 30 mm Hg or greater on exercise . A total of 739 patients had dyspnea , of which 312 met exclusion criteria and 150 refused to participate . Among the remaining 277 , 30 had known PAH and 247 had unexplained dyspnea and underwent echocardiography ;  PAH was suspected in 18 and confirmed in 5 , to give a total of 35 cases . The prevalence was thus 0.46 % ( 95 % confidence interval , 0.32 - 0.64 % ) . All new cases had relatively milder PAH . CONCLUSIONS The prevalence of HIV-associated PAH is about the same as it was in the early 1990s . Given the current good long-term prognosis of patients with HIV , the severity of PAH in HIV-infected patients , and the absence of predictive factors , careful screening for PAH is warranted for patients with unexplained dyspnea BACKGROUND The Heart of Soweto Study aims to increase our underst and ing of the characteristics and burden imposed by heart disease in an urban African community in probable epidemiological transition . We aim ed to investigate the clinical range of disorders related to cardiovascular disease in patients presenting for the first time to a tertiary-care centre . METHODS From Jan 1 to Dec 31 , 2006 , we recorded data for 4162 patients with confirmed cases of cardiovascular disease ( 1593 newly diagnosed and 2569 previously diagnosed and under treatment ) who attended the cardiology unit at the Chris Hani Bar 
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Conclusion The prevalence of PH is relatively high in some population s in Africa , perhaps mainly driven by left heart diseases , highlighting the need for context -specific interventions