Pericardial involvement in human immunodeficiency virus infection.

Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Pericardial involvement in human immunodeficiency virus infection.

Chest. 1999 Feb;115(2):418-22. Unique Identifier : AIDSLINE MED/99149687
Silva-Cardoso J; Moura B; Martins L; Mota-Miranda A; Rocha-Goncalves F; Lecour H; Oporto Cardiovascular Research and Development Unit (JNICT; 51/94), Porto Medical School, Hospital de S. Joao, Portugal.

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.

Keywords: JOURNAL ARTICLE Adult Cardiac Tamponade/ETIOLOGY Female Heart Diseases/*ETIOLOGY Human HIV Infections/*COMPLICATIONS Male Pericardial Effusion/ETIOLOGY *Pericardium Prospective Studies
990530
A9950888

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