Cardiac diseases in AIDS natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Presence of cardiac conditions like pericarditis (even if asymptomatic), cardiomyopathy and pulmonary hypertension in HIV infected patients carries poor prognosis.

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 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 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.

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