Clinical and echocardiographic findings in HIV patients with pericardial effusion

Pericardial effusion (PE) is frequently found in patients infected with the human immunodeficiency virus (HIV), but its clinical significance remains unclear. Our purpose was to study the manifestations of HIV-infected patients with PE and the coexistence of these manifestations with other echocardiographic abnormalities, compared with patients without PE.

We reviewed 141 HIV-infected patients in whom echocardiographic study was performed. We studied their epidemiological, clinical, hematological, immunological, electrocardiographic (ECG) and echocardiographic characteristics and their in-hospital outcome.

Patients with PE (n = 55), compared with those without PE (n = 86), were more often clinical stage C and immunological stage 3, had left-ventricular dysfunction and right-ventricular dilatation more frequently, and had been diagnosed as HIV-positive for a longer time. Seven patients with moderate to severe PE developed cardiac tamponade. Compared with patients with small PE (n = 34), those with moderate to large PE (n = 21), had pericardial rub, ECG repolarization abnormalities consistent with pericarditis, immunological stage 3, left-ventricular dysfunction and right-ventricular dilatation more frequently. In 3 patients, cardiac tamponade disappeared after anti-tuberculous therapy; in 3 cases, pericardial drainage was performed (anti-tuberculous therapy was not attempted); 1 patient with cardiac tamponade was not drainaged because he was a terminal patient with an extensive lymphoma.

PE in HIV-infected patients is associated with (1) advanced stages of infection, and (2) left-ventricular dysfunction and right-ventricular dilatation; (3) presence of pericardial rub and ECG alterations consistent with pericarditis suggests the existence of moderate to large PE.