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]

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)

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[pmid7586308-1] 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)

[pmid10047635-2] 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)

[pmid7781340-3] 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)

[pmid10760308-4] 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)

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