HIV induced pericarditis medical therapy
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HIV induced pericarditis medical therapy On the Web |
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Risk calculators and risk factors for HIV induced pericarditis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S. Ramyar Ghandriz MD[2]
Overview
Medical Therapy
- Asymptomatic with mild to moderate pericardial effusion:
- Mostly idiopathic and resolves spontaneously.
- However, asymptomatic effusions in HIV occur in advanced stages of the disease or they signal the onset of full-blown AIDS. These asymptomatic effusions require treatment to improve survival.[1] HAART therapy has significantly reduced the incidence and severity of cardiac complications associated with HIV.[2][3]
- Large pericardial effusions with unknown etiology:
- Empiric antituberculous therapy for M.tuberculosis have shown some benefit in patients with AIDS.[4][5][6]
- Other causes of pericarditis, including bacterial and fungal infections, should be identified and treated accordingly.
- Pericarditis due to lymphoma:
- Radiation and chemotherapy have been tried.[7][8] However, the response has been transient,[9] and the associated chemotherapy has significantly increased the risk of death secondary to opportunistic infections.[7]
Supportive Trial Data
- The incidence of pericardial effusion in patients with asymptomatic AIDS was 11% per year before the introduction of effective highly active antiretroviral therapy (HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of CD4 count and albumin levels.[10]
References
- ↑ Barbaro G (2003) Pathogenesis of HIV-associated cardiovascular disease. Adv Cardiol 40 ():49-70. PMID: 14533546
- ↑ Ntsekhe M, Hakim J (2005) Impact of human immunodeficiency virus infection on cardiovascular disease in Africa. Circulation 112 (23):3602-7. DOI:10.1161/CIRCULATIONAHA.105.549220 PMID: 16330702
- ↑ Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF (2006) Cardiovascular disease in HIV infection. Am Heart J 151 (6):1147-55. DOI:10.1016/j.ahj.2005.07.030 PMID: 16781213
- ↑ Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med 324 (5):289-94. DOI:10.1056/NEJM199101313240503 PMID: 1898769
- ↑ Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA 256 (3):362-6. PMID: 3723722
- ↑ Syed FF, Mayosi BM (2007) A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis 50 (3):218-36. DOI:10.1016/j.pcad.2007.03.002 PMID: 17976506
- ↑ 7.0 7.1 Levine AM (1992) AIDS-associated malignant lymphoma. Med Clin North Am 76 (1):253-68. PMID: 1727539
- ↑ Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) Primary effusion lymphoma in pleural and pericardial cavities with multiple solid nodal and extra-nodal involvement in a human immunodeficiency virus-positive patient. Leuk Lymphoma 48 (1):209-11. DOI:10.1080/10428190601019880 PMID: 17325873
- ↑ Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) Cardiac involvement in HIV-related non-Hodgkin's lymphoma: a case report and short review of the literature. Ann Hematol 77 (1-2):75-8. PMID: 9760158
- ↑ Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB; et al. (1995). "Pericardial effusion in AIDS. Incidence and survival". Circulation. 92 (11): 3229–34. PMID 7586308.