HIV Infection - Pericardial Effusion

5/15/02 (Lassiter)

Question: What are aspects of HIV-associated pericardial effusion?

 Link Directly to Fulltext article in Ovid

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Unique Identifier:10027441

Authors: Silva-Cardoso J. Moura B. Martins L. Mota-Miranda A. Rocha-Goncalves F. Lecour H.

Institution: Oporto Cardiovascular Research and Development Unit (JNICT 51/94), Porto Medical School, Hospital de S. Joao, Portugal.

Title: Pericardial involvement in human immunodeficiency virus infection.

Source: Chest. 115(2):418-22, 1999 Feb.

Abstract: STUDY OBJECTIVES: Previous studies have showed that the pericardium is frequently involved in HIV infection. However, the characteristics and etiology of the pericardial abnormalities that have been found remained poorly defined. We analyzed the features of pericardial involvement in these patients and investigated the clinical variables associated with moderate and severe effusions. DESIGN: Prospective, clinical, and echocardiographic study. SETTING: The service of infectious diseases of a university hospital. PATIENTS: 181 consecutive patients at all stages of HIV infection. RESULTS: Only one patient (0.55%) had acute pericarditis. Seventy-five patients (41%) had an asymptomatic pericardial effusion; in 23 patients (13% of all patients), the effusion was either moderate or severe. Ten cases (5.5% of all patients) of moderate or severe effusions resulted in right atrium diastolic compression, and three of these cases (1.6% of all patients) required pericardiocentesis for the management of tamponade. Six patients (3%) presented with echogenic pericardial masses of undetermined etiology. A moderate or severe effusion was present in a greater number of patients with symptomatic HIV infection than was present in asymptomatic HIV-infected patients, respectively: 17 vs 2% (p = 0.015). The following are variables independently associated with moderate or severe pericardial effusions: heart failure (odds ratio, 20.3; p = 0.0001); Kaposi's sarcoma (odds ratio, 8.6; p = 0.01), tuberculosis (TB; odds ratio, 47.2; p = 0.0006); and other pulmonary infections (odds ratio,15.0; p = 0.02). CONCLUSIONS: Most of these moderate or severe effusions are clinically unsuspected, but they can lead to life-threatening tamponade. This fact seems to justify echocardiographic surveillance in HIV-infected patients, especially in those with heart failure, Kaposi's sarcoma, TB, or other pulmonary infections.

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Unique Identifier:9286499

Authors: Moreno R. Villacastin JP. Bueno H. Lopez de Sa E. Lopez-Sendon JL. Bobadilla JF. Garcia-Fernandez MA. Delcan JL.

Institution: Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.

Title: Clinical and echocardiographic findings in HIV patients with pericardial effusion.

Source: Cardiology. 88(5):397-400, 1997 Sep-Oct.

Abstract: BACKGROUND AND OBJECTIVES: Pericardial effusion (PE) is frequently found in patients infected with the human immunodeficiency virus (HIV), but its clinical significance remains unclear. Our purpose was to study the manifestations of HIV-infected patients with PE and the coexistence of these manifestations with other echocardiographic abnormalities, compared with patients without PE. METHODS: We reviewed 141 HIV-infected patients in whom echocardiographic study was performed. We studied their epidemiological, clinical, hematological, immunological, electrocardiographic (ECG) and echocardiographic characteristics and their in-hospital outcome. RESULTS: Patients with PE (n = 55), compared with those without PE (n = 86), were more often clinical stage C and immunological stage 3, had left-ventricular dysfunction and right-ventricular dilatation more frequently, and had been diagnosed as HIV-positive for a longer time. Seven patients with moderate to severe PE developed cardiac tamponade. Compared with patients with small PE (n = 34), those with moderate to large PE (n = 21), had pericardial rub, ECG repolarization abnormalities consistent with pericarditis, immunological stage 3, left-ventricular dysfunction and right-ventricular dilatation more frequently. In 3 patients, cardiac tamponade disappeared after anti-tuberculous therapy; in 3 cases, pericardial drainage was performed (anti-tuberculous therapy was not attempted); 1 patient with cardiac tamponade was not drainaged because he was a terminal patient with an extensive lymphoma. CONCLUSIONS: PE in HIV-infected patients is associated with (1) advanced stages of infection, and (2) left-ventricular dysfunction and right-ventricular dilatation; (3) presence of pericardial rub and ECG alterations consistent with pericarditis suggests the existence of moderate to large PE. CAS Registry/EC Number 60-27-5 (Creatinine).