Study objectives: Previous studies have showed that the
pericardium is frequently involved in HIV infection. However, the
characteristics and etiology of the pericardial abnormalities that have
been found remained poorly defined. We analyzed the features of
pericardial involvement in these patients and investigated the clinical
variables associated with moderate and severe effusions.
Design: Prospective, clinical, and echocardiographic
Setting: The service of infectious diseases of
a university hospital.
Patients: 181 consecutive
patients at all stages of HIV infection.
Only one patient (0.55%) had acute pericarditis. Seventy-five patients
(41%) had an asymptomatic pericardial effusion; in 23 patients (13%
of all patients), the effusion was either moderate or severe. Ten cases
(5.5% of all patients) of moderate or severe effusions resulted in
right atrium diastolic compression, and three of these cases (1.6% of
all patients) required pericardiocentesis for the management of
tamponade. Six patients (3%) presented with echogenic pericardial
masses of undetermined etiology. A moderate or severe effusion was
present in a greater number of patients with symptomatic HIV infection
than was present in asymptomatic HIV-infected patients, respectively:
17 vs 2% (p = 0.015). The following are variables independently
associated with moderate or severe pericardial effusions: heart failure
(odds ratio, 20.3; p = 0.0001); Kaposi’s sarcoma (odds ratio, 8.6;
p = 0.01), tuberculosis (TB; odds ratio, 47.2; p = 0.0006); and
other pulmonary infections (odds ratio,15.0; p = 0.02).
Conclusions: Most of these moderate or severe effusions are
clinically unsuspected, but they can lead to life-threatening
tamponade. This fact seems to justify echocardiographic surveillance in
HIV-infected patients, especially in those with heart failure,
Kaposi’s sarcoma, TB, or other pulmonary
Abbreviations: ARC = AIDS-related complex;
TB = tuberculosis