HIV induced pericarditis: Difference between revisions
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:*[[Pulmonary hypertension]] | :*[[Pulmonary hypertension]] | ||
:*[[Coronary artery disease]] | :*[[Coronary artery disease]] | ||
==Epidemiology and demographics== | ==Epidemiology and demographics== | ||
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*The incidence of AIDS-related cardiac disease is very high in Africa in comparison to that seen in the developed countries. In the period from 1993 to 1999 in Burkina Faso, '''79%''' of AIDS patients exhibited cardiac involvement, whereas in an Italian study in the period from 1992 to 1995, the incidence of AIDS-related cardiac disease was '''6.5%'''<ref name="pmid15124176">{{cite journal| author=Pugliese A, Gennero L, Vidotto V, Beltramo T, Petrini S, Torre D| title=A review of cardiovascular complications accompanying AIDS. | journal=Cell Biochem Funct | year= 2004 | volume= 22 | issue= 3 | pages= 137-41 | pmid=15124176 | doi=10.1002/cbf.1095 | pmc= | url= }} </ref>. | *The incidence of AIDS-related cardiac disease is very high in Africa in comparison to that seen in the developed countries. In the period from 1993 to 1999 in Burkina Faso, '''79%''' of AIDS patients exhibited cardiac involvement, whereas in an Italian study in the period from 1992 to 1995, the incidence of AIDS-related cardiac disease was '''6.5%'''<ref name="pmid15124176">{{cite journal| author=Pugliese A, Gennero L, Vidotto V, Beltramo T, Petrini S, Torre D| title=A review of cardiovascular complications accompanying AIDS. | journal=Cell Biochem Funct | year= 2004 | volume= 22 | issue= 3 | pages= 137-41 | pmid=15124176 | doi=10.1002/cbf.1095 | pmc= | url= }} </ref>. | ||
==Pathophysiology== | ==Pathophysiology== | ||
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:*In advanced HIV disease, effusions are a part of '''generalized seroeffusive process''' involving pleural and peritoneal surfaces, possibly related to enhanced cytokine expression, resulting in moderate to large effusions. | :*In advanced HIV disease, effusions are a part of '''generalized seroeffusive process''' involving pleural and peritoneal surfaces, possibly related to enhanced cytokine expression, resulting in moderate to large effusions. | ||
:*[[Congestive heart failure]], [[Kaposi sarcoma]], and [[Tuberculosis]] are '''independently''' associated with moderate to large effusions. | :*[[Congestive heart failure]], [[Kaposi sarcoma]], and [[Tuberculosis]] are '''independently''' associated with moderate to large effusions. | ||
==Etiology== | ==Etiology== | ||
It is often difficult to identify the etiology of [[pericardial effusion]] in HIV-infected patients. | It is often difficult to identify the etiology of [[pericardial effusion]] in HIV-infected patients. | ||
The common organisms isolated are: | The common organisms isolated are: | ||
:* | :*[[Mycobacterium tuberculosis]] which is the most common etiology for pericardial effusion in African HIV-infected patients<ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref><ref name="pmid16781213">{{cite journal| author=Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF| title=Cardiovascular disease in HIV infection. | journal=Am Heart J | year= 2006 | volume= 151 | issue= 6 | pages= 1147-55 | pmid=16781213 | doi=10.1016/j.ahj.2005.07.030 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781213 }} </ref> | ||
:* | :*[[Staphylococcus aureus]] <ref name="pmid3467225">Stechel RP, Cooper DJ, Greenspan J, Pizzarello RA, Tenenbaum MJ (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3467225 Staphylococcal pericarditis in a homosexual patient with AIDS-related complex.] ''N Y State J Med'' 86 (11):592-3. PMID: [http://pubmed.gov/3467225 3467225]</ref> <ref name="pmid8306779">Decker CF, Tuazon CU (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8306779 Staphylococcus aureus pericarditis in HIV-infected patients.] ''Chest'' 105 (2):615-6. PMID: [http://pubmed.gov/8306779 8306779]</ref> | ||
:* | :*[[Cryptococcus neoformans]] <ref name="pmid4045235">Schuster M, Valentine F, Holzman R (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4045235 Cryptococcal pericarditis in an intravenous drug abuser.] ''J Infect Dis'' 152 (4):842. PMID: [http://pubmed.gov/4045235 4045235]</ref> | ||
:* | :*[[Herpes simplex]] <ref name="pmid3035442">Freedberg RS, Gindea AJ, Dieterich DT, Greene JB (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3035442 Herpes simplex pericarditis in AIDS.] ''N Y State J Med'' 87 (5):304-6. PMID: [http://pubmed.gov/3035442 3035442]</ref> | ||
'''Supportive trial data:''' | '''Supportive trial data:''' | ||
*A retrospective study <ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref> of 29 patients with AIDS-related pericardial effusion who underwent fluid cultures and pericardial biopsy, etiology was established only in 7% patients. The causes included: | *A retrospective study <ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref> of 29 patients with AIDS-related pericardial effusion who underwent fluid cultures and pericardial biopsy, etiology was established only in 7% patients. The causes included: | ||
::* | ::*Mycobacterium tuberculosis (1%), | ||
::* | ::*Staphylococcus aureus(1%), and | ||
::*Neoplasms (2% adenocarcinoma and 3% [[lymphoma]]) | ::*Neoplasms (2% adenocarcinoma and 3% [[lymphoma]]) | ||
*Another study that evaluated pericardial effusions in 17 patients with HIV <ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref>, revealed etiologic evidence in 5 patients of which 2 were found to have lymphoma, and 1 each had staphylococcus aureus, mycobacterium tuberculosis, and fungal infection. | *Another study that evaluated pericardial effusions in 17 patients with HIV <ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref>, revealed etiologic evidence in 5 patients of which 2 were found to have lymphoma, and 1 each had staphylococcus aureus, mycobacterium tuberculosis, and fungal infection. | ||
==Diagnosis== | ==Diagnosis== | ||
====History and symptoms:==== | ====History and symptoms:==== | ||
The frequency and severity of the | The frequency and severity of the symptoms varies with the stage of infection and the degree [[pericardium|pericardial]] involvement. | ||
*Majority of the are '''asymptomatic''' and present with an increase in the cardiac silhouette on chest x-ray. | *Majority of the patients are '''asymptomatic''' and present with an increase in the cardiac silhouette on chest x-ray. | ||
*Symptomatic patients present with the following: | *Symptomatic patients present with the following: | ||
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::*[[Cough]] | ::*[[Cough]] | ||
::*[[Ankle edema]] and/or [[ascites]] | ::*[[Ankle edema]] and/or [[ascites]] | ||
====Physical Examination:==== | ====Physical Examination:==== | ||
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*[[hypotension]] (in [[cardiac tamponade]]), | *[[hypotension]] (in [[cardiac tamponade]]), | ||
'''Neck:''' | '''Neck:''' | ||
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*[[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]] may be present. | *[[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]] may be present. | ||
<youtube v=uB1c2zvkaew/> | <youtube v=uB1c2zvkaew/> | ||
'''Chest:''' | '''Chest:''' | ||
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<youtube v=Jtk2vVgQuU0/> | <youtube v=Jtk2vVgQuU0/> | ||
*'''[[Pericardial rub]]''' | *'''[[Pericardial rub]]''' | ||
<youtube v=EUCp_3_vwtw/> | <youtube v=EUCp_3_vwtw/> | ||
'''Abdomen:''' | '''Abdomen:''' | ||
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<youtube v=B8OX3T4c7PU/>> | <youtube v=B8OX3T4c7PU/>> | ||
'''Extremities:''' [[Ankle edema]] | |||
====CXR:==== | |||
====Electrocardiogram:==== | |||
====Echocardiography:==== | |||
Approximately one third of the patients with symptomatic [[pericardial effusion]] can develop [[cardiac tamponade]].<ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref> The echocardiogram below demonstrates '''swinging motion of the heart''' in [[cardiac tamponade]]. | |||
<youtube v=U4xQ3-VRiNg/> | |||
==Treatment== | ==Treatment== | ||
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*'''Pericarditis due to [[lymphoma]]:''' radiation and chemotherapy have been tried. <ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> <ref name="pmid17325873">Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17325873 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. [http://dx.doi.org/10.1080/10428190601019880 DOI:10.1080/10428190601019880] PMID: [http://pubmed.gov/17325873 17325873]</ref> The response however has been transient <ref name="pmid9760158">Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9760158 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: [http://pubmed.gov/9760158 9760158]</ref> and associated chemotherapy has a significantly increased the risk of death due to opportunistic infections.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> | *'''Pericarditis due to [[lymphoma]]:''' radiation and chemotherapy have been tried. <ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> <ref name="pmid17325873">Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17325873 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. [http://dx.doi.org/10.1080/10428190601019880 DOI:10.1080/10428190601019880] PMID: [http://pubmed.gov/17325873 17325873]</ref> The response however has been transient <ref name="pmid9760158">Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9760158 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: [http://pubmed.gov/9760158 9760158]</ref> and associated chemotherapy has a significantly increased the risk of death due to opportunistic infections.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> | ||
==Prognosis== | ==Prognosis== | ||
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*Pericarditis in [[HIV]] patients is also associated with '''shortened survival'''. <ref name="pmid14533546">Barbaro G (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14533546 Pathogenesis of HIV-associated cardiovascular disease.] ''Adv Cardiol'' 40 ():49-70. PMID: [http://pubmed.gov/14533546 14533546]</ref> | *Pericarditis in [[HIV]] patients is also associated with '''shortened survival'''. <ref name="pmid14533546">Barbaro G (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14533546 Pathogenesis of HIV-associated cardiovascular disease.] ''Adv Cardiol'' 40 ():49-70. PMID: [http://pubmed.gov/14533546 14533546]</ref> | ||
'''Supportive trial data:''' | '''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 level<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref>. | *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 level<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref>. | ||
==References== | ==References== |
Revision as of 18:23, 1 July 2011
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HIV induced pericarditis On the Web |
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Risk calculators and risk factors for HIV induced pericarditis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
A wide variety of cardiovascular complications are seen in advanced HIV infected patients. The most common are:
Epidemiology and demographics
Pericardial diseases in the form of pericardial effusion or cardiac tamponade[5][7][8][9] have been recognized as a complication since HIV infection was first reported in 1981.
- In a small autopsy study, 24% cases reported major cardiac pathology [10].
- 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 level[5].
- The incidence of AIDS-related cardiac disease is very high in Africa in comparison to that seen in the developed countries. In the period from 1993 to 1999 in Burkina Faso, 79% of AIDS patients exhibited cardiac involvement, whereas in an Italian study in the period from 1992 to 1995, the incidence of AIDS-related cardiac disease was 6.5%[11].
Pathophysiology
Patients with advanced HIV have pericardial involvement at some point and the most common abnormality is pericardial effusion[12].
- Asymptomatic effusions are mostly small and idiopathic.
- In advanced HIV disease, effusions are a part of generalized seroeffusive process involving pleural and peritoneal surfaces, possibly related to enhanced cytokine expression, resulting in moderate to large effusions.
- Congestive heart failure, Kaposi sarcoma, and Tuberculosis are independently associated with moderate to large effusions.
Etiology
It is often difficult to identify the etiology of pericardial effusion in HIV-infected patients. The common organisms isolated are:
- Mycobacterium tuberculosis which is the most common etiology for pericardial effusion in African HIV-infected patients[13][14]
- Staphylococcus aureus [15] [16]
- Cryptococcus neoformans [17]
- Herpes simplex [18]
Supportive trial data:
- A retrospective study [19] of 29 patients with AIDS-related pericardial effusion who underwent fluid cultures and pericardial biopsy, etiology was established only in 7% patients. The causes included:
- Mycobacterium tuberculosis (1%),
- Staphylococcus aureus(1%), and
- Neoplasms (2% adenocarcinoma and 3% lymphoma)
- Another study that evaluated pericardial effusions in 17 patients with HIV [4], revealed etiologic evidence in 5 patients of which 2 were found to have lymphoma, and 1 each had staphylococcus aureus, mycobacterium tuberculosis, and fungal infection.
Diagnosis
History and symptoms:
The frequency and severity of the symptoms varies with the stage of infection and the degree pericardial involvement.
- Majority of the patients are asymptomatic and present with an increase in the cardiac silhouette on chest x-ray.
- Symptomatic patients present with the following:
- Chest pain: characteristically sharp and pleuritic in nature, exacerbated by inspiration and relieved by sitting up and leaning forward.
- breathlessness
- Malaise
- Fever
- Cough
- Ankle edema and/or ascites
Physical Examination:
Vitals:
- pulsus paradoxus and
- hypotension (in cardiac tamponade),
Neck:
- Jugular venous distension with a prominent Y descent and Kussmaul's sign may be present.
<youtube v=uB1c2zvkaew/>
Chest:
- Ewart's sign: Dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid may be present.
- Pericardial knock
<youtube v=Jtk2vVgQuU0/>
<youtube v=EUCp_3_vwtw/>
Abdomen:
- Hepatojugular reflux may be present
<youtube v=B8OX3T4c7PU/>>
Extremities: Ankle edema
CXR:
Electrocardiogram:
Echocardiography:
Approximately one third of the patients with symptomatic pericardial effusion can develop cardiac tamponade.[9] The echocardiogram below demonstrates swinging motion of the heart in cardiac tamponade. <youtube v=U4xQ3-VRiNg/>
Treatment
- Asymptomatic with mild to moderate pericardial effusion:
- usually idiopathic and will resolve spontaneously.
- However, asymptomatic effusions in HIV occurs in advanced stages of the disease or heralds the onset of full-blown AIDS and hence requires treatment to improve survival.[12] HAART therapy has significantly reduced the incidence and severity of cardiac complications associated with HIV.[20] [14]
- Symptomatic large effusions even without cardiac tamponade: require pericardiocentesis and obtain cultures, cytology to identify the possible etiology.
- Pericarditis with cardiac tamponade: occurs in 33-40% patients.[9] This warrants immediate pericardiocentesis and a catheter is left in the pericardial sac to drain fluid by underwater-seal suction for the next 48 hours.
- Recurrent pericardial effusion: Either subxiphoid pericardiotomy with creation of a pericardial window [19] [21] or balloon pericardiotomy can be considered.[22] [23]
- Large pericardial effusions with unknown etiology: empiric therapy with conventional antituberculous therapy for M.tuberculosis have shown some benefit in patients with AIDS. [24] [25] [26]
- Other causes of pericarditis such as bacterial or fungal infections also should be identified and treated accordingly.
- Pericarditis due to lymphoma: radiation and chemotherapy have been tried. [27] [28] The response however has been transient [29] and associated chemotherapy has a significantly increased the risk of death due to opportunistic infections.[27]
Prognosis
- Pericarditis in patients with HIV occurs in advanced stages of the disease or heralds the onset of full-blown AIDS and hence is a bad prognostic sign. [5] [30] [31] [32]
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 level[5].
References
- ↑ Corallo S, Mutinelli MR, Moroni M, Lazzarin A, Celano V, Repossini A et al. (1988) Echocardiography detects myocardial damage in AIDS: prospective study in 102 patients. Eur Heart J 9 (8):887-92. PMID: 3181175
- ↑ Himelman RB, Chung WS, Chernoff DN, Schiller NB, Hollander H (1989) Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study. J Am Coll Cardiol 13 (5):1030-6. PMID: 2926051
- ↑ De Castro S, Migliau G, Silvestri A, D'Amati G, Giannantoni P, Cartoni D et al. (1992) Heart involvement in AIDS: a prospective study during various stages of the disease. Eur Heart J 13 (11):1452-9. PMID: 1464334
- ↑ 4.0 4.1 Hsia J, Ross AM (1994) Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection. Am J Cardiol 74 (1):94-6. PMID: 8017317
- ↑ 5.0 5.1 5.2 5.3 5.4 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
- ↑ Estok L, Wallach F (1998) Cardiac tamponade in a patient with AIDS: a review of pericardial disease in patients with HIV infection. Mt Sinai J Med 65 (1):33-9. PMID: 9458682
- ↑ Stotka JL, Good CB, Downer WR, Kapoor WN (1989). "Pericardial effusion and tamponade due to Kaposi's sarcoma in acquired immunodeficiency syndrome". Chest. 95 (6): 1359–61. PMID 2721281.
- ↑ Karve MM, Murali MR, Shah HM, Phelps KR (1992). "Rapid evolution of cardiac tamponade due to bacterial pericarditis in two patients with HIV-1 infection". Chest. 101 (5): 1461–3. PMID 1582323.
- ↑ 9.0 9.1 9.2 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. Am Heart J 137 (3):516-21. PMID: 10047635
- ↑ Cammarosano C, Lewis W (1985). "Cardiac lesions in acquired immune deficiency syndrome (AIDS)". J Am Coll Cardiol. 5 (3): 703–6. PMID 3973269.
- ↑ Pugliese A, Gennero L, Vidotto V, Beltramo T, Petrini S, Torre D (2004). "A review of cardiovascular complications accompanying AIDS". Cell Biochem Funct. 22 (3): 137–41. doi:10.1002/cbf.1095. PMID 15124176.
- ↑ 12.0 12.1 12.2 Barbaro G (2003). "Pathogenesis of HIV-associated cardiovascular disease". Adv Cardiol. 40: 49–70. PMID 14533546.
- ↑ Mayosi BM, Burgess LJ, Doubell AF (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703.
- ↑ 14.0 14.1 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.
- ↑ Stechel RP, Cooper DJ, Greenspan J, Pizzarello RA, Tenenbaum MJ (1986) Staphylococcal pericarditis in a homosexual patient with AIDS-related complex. N Y State J Med 86 (11):592-3. PMID: 3467225
- ↑ Decker CF, Tuazon CU (1994) Staphylococcus aureus pericarditis in HIV-infected patients. Chest 105 (2):615-6. PMID: 8306779
- ↑ Schuster M, Valentine F, Holzman R (1985) Cryptococcal pericarditis in an intravenous drug abuser. J Infect Dis 152 (4):842. PMID: 4045235
- ↑ Freedberg RS, Gindea AJ, Dieterich DT, Greene JB (1987) Herpes simplex pericarditis in AIDS. N Y State J Med 87 (5):304-6. PMID: 3035442
- ↑ 19.0 19.1 Flum DR, McGinn JT, Tyras DH (1995) The role of the 'pericardial window' in AIDS. Chest 107 (6):1522-5. PMID: 7781340
- ↑ 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
- ↑ Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998) Pericardial effusion and AIDS: benefits of surgical drainage. Eur J Cardiothorac Surg 13 (2):165-9. PMID: 9583822
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