Cardiac diseases in AIDS natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Presence of cardiac conditions like pericarditis (even if asymptomatic), cardiomyopathy and pulmonary hypertension in HIV infected patients carries poor prognosis.
Natural History
The majority of pericardial effusions (80%) in the setting of AIDS are small and asymptomatic. Studies have reported that these effusions resolve spontaneously in 42% of the patients [1].
Complications
Complications from involvement of heart in AIDS include:
- Cardiac tamponade from severe pericardial effusions [2]
- Heart failure from dilated cardiomyopathy (DCM)
- Disseminated intravascular coagulation (DIC), systemic embolization and stroke from infective endocarditis
- Valvular regurgitations
- Heart blocks
- Superior vena caval syndrome due to cardiac tumors
- Death
Prognosis
Prognosis is very poor in:
- Pericarditis: Mortality is significantly higher with shortened survival in patients with effusions even if they resolve spontaneously over time [1][2][3].
- Cardiomyopathy: Cardiomyopathy associated with HIV infection carries worst prognosis compared to other non-ischemic types of cardiomyopathy. Rapid onset CHF has a poorer prognosis than gradual onset CHF [4].
- Pulmonary hypertension: Median survival is 6 months.
References
- ↑ 1.0 1.1 Heidenreich PA, Eisenberg MJ, Kee LL; et al. (1995). "Pericardial effusion in AIDS. Incidence and survival". Circulation. 92 (11): 3229–34. PMID 7586308. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). "Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature". American Heart Journal. 137 (3): 516–21. PMID 10047635. Unknown parameter
|month=ignored (help) - ↑ Flum DR, McGinn JT, Tyras DH (1995). "The role of the 'pericardial window' in AIDS". Chest. 107 (6): 1522–5. PMID 7781340. Unknown parameter
|month=ignored (help) - ↑ Felker GM, Thompson RE, Hare JM; et al. (2000). "Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy". The New England Journal of Medicine. 342 (15): 1077–84. doi:10.1056/NEJM200004133421502. PMID 10760308. Unknown parameter
|month=ignored (help)