HIV induced pericarditis treatment


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Treatment

 * Asymptomatic with mild to moderate pericardial effusion:
 * Mostly idiopathic and resolves spontaneously.
 * However, asymptomatic effusions in HIV occurs in advanced stages of the disease or heralds the onset of full-blown AIDS and hence requires treatment to improve survival. HAART therapy has significantly reduced the incidence and severity of cardiac complications associated with HIV.


 * Symptomatic large effusions without cardiac tamponade: requires pericardiocentesis for both therapeutic and diagnostic purposes, to identify possible etiology.


 * Pericarditis with cardiac tamponade: occurs in 33-40% patients. This warrants immediate pericardiocentesis and a catheter is placed in the pericardial sac for the next 48 hours to continuously drain fluid by underwater-seal suction.


 * Recurrent pericardial effusion: Either subxiphoid pericardiotomy with creation of a pericardial window or balloon pericardiotomy can be considered.


 * Large pericardial effusions with unknown etiology: Empiric antituberculous therapy for M.tuberculosis have shown some benefit in patients with AIDS.


 * Other causes of pericarditis such as bacterial or fungal infections also should be identified and treated accordingly.


 * Pericarditis due to lymphoma: radiation and chemotherapy have been tried. The response however has been transient and the associated chemotherapy has significantly increased the risk of death secondary to opportunistic infections.

Supportive trial data:
 * The incidence of pericardial effusion in patients with asymptomatic AIDS was 11% per year before the introduction of effective highly active antiretroviral therapy (HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of CD4 count and albumin level.