Pericardial effusion of HIV-infected patients - results of a prospective multicenter cohort study in the era of antiretroviral therapy

Abstract

BackgroundPatients with human immunodeficiency virus (HIV) infection have an increased risk of cardiovascular diseases. Previous publications described pericardial effusion as one of the most common HlV-associated cardiac affiliations. The aim of the current study was to investigate if pericardial effusion still has a relevant meaning of HIV-infected patients in the era of antiretroviral therapy.MethodsThe HIV-HEART (HIV-infection and HEART disease) study is a cardiology driven, prospective and multicenter cohort study. Outpatients with a known HIV-infection were recruited during a 20 month period in a consecutive manner from September 2004 to May 2006. The study comprehends classic parameters of HIV-infection, comprising CD4-cell count (cluster of differentiation) and virus load, as well as non-invasive tests of cardiac diseases, including a thorough transthoracic echocardiography.Results802 HIV-infected patients (female: 16.6%) with a mean age of 44.2 ± 10.3 years, were included. Duration of HIV-infection since initial diagnosis was 7.6 ± 5.8 years. Of all participants, 85.2% received antiretroviral therapy. Virus load was detectable in 34.4% and CD4 - cell count was in 12.4% less than 200 cells/μL. Pericardial effusions were present in only two patients of the analysed population. None of the participants had signs of a relevant cardiovascular impairment by pericardial effusion.ConclusionsOur results demonstrate that the era of antiretroviral therapy goes along with low rates of pericardial effusions in HIV-infected outpatients. Our findings are in contrast to the results of publications, performed before the common use of antiretroviral therapy.

HIV-1–Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema

“…33 With the introduction of ART, there was a marked reduction in their incidence. The Cardiovascular Diseases in HIV-related Subjects (HIV-Heart Study) 34 investigated 802 patients with HIV, 85% of whom were on ART, and found echocardiographic evidence of pericardial effusions in only 2 patients. Our study, using comprehensive CMR, has shown a pericardial effusion incidence of by guest on May 11, 2018 http://circimaging.ahajournals.org/ Downloaded from HIV-1-Associated Cardiovascular Disease 58% in subjects on ART and 77% in those who were ART naive.…”

Association of Human Immunodeficiency Virus Infection with Exposure to Highly Active Antiretroviral Therapy and Its Adverse Cardiovascular Effects

“…The prevalence of effusion in asymptomatic AIDS patients reaches a mean of about 22% after 25 months, rising over time. 109 In a recent study, only 2 of 802 HAART-treated patients had clinically important effusions, indicating the greatly reduced incidence with treatment of HIV. 109 …”

“…Effusion nearly triples the risk of death among AIDS patients. 109 Immune reconstitution inflammatory syndrome can cause pericardial effusions and pericarditis in patients coinfected with HIV and tuberculosis. 112 Monitoring and Therapy Baseline echocardiographic and electrocardiographic measurements should be obtained from all HIV-infected patients with evidence of heart failure, Kaposi's sarcoma, tuberculosis, and/or unexplained shortness of breath.…”

“…In a retrospective series from a city hospital, 13 of 37 (35%) patients with cardiac tamponade had HIV infection. 109 Although rare, tuberculosis has been a presenting infection for pericardial effusions in underdeveloped geographic areas where tuberculosis is prevalent. 109,110 These cases have therapeutic implications and deserve special attention.…”

“…109 Although rare, tuberculosis has been a presenting infection for pericardial effusions in underdeveloped geographic areas where tuberculosis is prevalent. 109,110 These cases have therapeutic implications and deserve special attention. 111 Pathogenesis Pericardial effusion is often part of a generalized serous effusive process also involving pleural and peritoneal surfaces.…”