HIV induced pericarditis treatment: Difference between revisions
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==Treatment== | ==Treatment== | ||
* | *Asymptomatic with mild to moderate [[pericardial effusion]]: | ||
:*Mostly idiopathic and resolves spontaneously. | :*Mostly idiopathic and resolves spontaneously. | ||
:*However, asymptomatic effusions in [[HIV]] | :*However, asymptomatic effusions in [[HIV]] occur in advanced stages of the disease or they signal the onset of full-blown [[AIDS]]. These asymptomatic effusions require treatment to improve survival.<ref name="pmid14533546">Barbaro G (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14533546 Pathogenesis of HIV-associated cardiovascular disease.] ''Adv Cardiol'' 40 ():49-70. PMID: [http://pubmed.gov/14533546 14533546]</ref> [[HAART]] therapy has significantly reduced the incidence and severity of cardiac complications associated with [[HIV]].<ref name="pmid16330702">Ntsekhe M, Hakim J (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16330702 Impact of human immunodeficiency virus infection on cardiovascular disease in Africa.] ''Circulation'' 112 (23):3602-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.549220 DOI:10.1161/CIRCULATIONAHA.105.549220] PMID: [http://pubmed.gov/16330702 16330702]</ref><ref name="pmid16781213">Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16781213 Cardiovascular disease in HIV infection.] ''Am Heart J'' 151 (6):1147-55. [http://dx.doi.org/10.1016/j.ahj.2005.07.030 DOI:10.1016/j.ahj.2005.07.030] PMID: [http://pubmed.gov/16781213 16781213]</ref> | ||
* | *Symptomatic large effusions without [[cardiac tamponade]]: | ||
:*Requires [[pericardiocentesis]] for both therapeutic and diagnostic purposes, to identify possible etiology. | :*Requires [[pericardiocentesis]] for both therapeutic and diagnostic purposes, to identify possible etiology. | ||
* | *Pericarditis with [[cardiac tamponade]]: | ||
:*Occurs in 33-40% patients.<ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref> | :*Occurs in 33-40% of patients.<ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref> | ||
:*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. | :*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 [[Pericardial window|subxiphoid pericardiotomy with creation of a pericardial window]]<ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref><ref name="pmid9583822">Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9583822 Pericardial effusion and AIDS: benefits of surgical drainage.] ''Eur J Cardiothorac Surg'' 13 (2):165-9. PMID: [http://pubmed.gov/9583822 9583822]</ref> or balloon | :*Either [[Pericardial window|subxiphoid pericardiotomy with creation of a pericardial window]]<ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref><ref name="pmid9583822">Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9583822 Pericardial effusion and AIDS: benefits of surgical drainage.] ''Eur J Cardiothorac Surg'' 13 (2):165-9. PMID: [http://pubmed.gov/9583822 9583822]</ref> or balloon pericardiotomy can be considered.<ref name="pmid8417048">Ziskind AA, Pearce AC, Lemmon CC, Burstein S, Gimple LW, Herrmann HC et al. (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8417048 Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases.] ''J Am Coll Cardiol'' 21 (1):1-5. PMID: [http://pubmed.gov/8417048 8417048]</ref><ref name="pmid15662494">Marcy PY, Bondiau PY, Brunner P (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15662494 Percutaneous treatment in patients presenting with malignant cardiac tamponade.] ''Eur Radiol'' 15 (9):2000-9. [http://dx.doi.org/10.1007/s00330-004-2611-y DOI:10.1007/s00330-004-2611-y] PMID: [http://pubmed.gov/15662494 15662494]</ref> | ||
* | *Large [[pericardial effusion]]s with unknown etiology: | ||
:*[[Tuberculous pericarditis#Anti-tuberculosis chemotherapy|Empiric antituberculous therapy]] for M.tuberculosis have shown some benefit in patients with AIDS.<ref name="pmid1898769">Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1898769 Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.] ''N Engl J Med'' 324 (5):289-94. [http://dx.doi.org/10.1056/NEJM199101313240503 DOI:10.1056/NEJM199101313240503] PMID: [http://pubmed.gov/1898769 1898769]</ref> <ref name="pmid3723722">Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3723722 Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS).] ''JAMA'' 256 (3):362-6. PMID: [http://pubmed.gov/3723722 3723722]</ref><ref name="pmid17976506">Syed FF, Mayosi BM (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17976506 A modern approach to tuberculous pericarditis.] ''Prog Cardiovasc Dis'' 50 (3):218-36. [http://dx.doi.org/10.1016/j.pcad.2007.03.002 DOI:10.1016/j.pcad.2007.03.002] PMID: [http://pubmed.gov/17976506 17976506]</ref> | :*[[Tuberculous pericarditis#Anti-tuberculosis chemotherapy|Empiric antituberculous therapy]] for M.tuberculosis have shown some benefit in patients with AIDS.<ref name="pmid1898769">Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1898769 Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.] ''N Engl J Med'' 324 (5):289-94. [http://dx.doi.org/10.1056/NEJM199101313240503 DOI:10.1056/NEJM199101313240503] PMID: [http://pubmed.gov/1898769 1898769]</ref><ref name="pmid3723722">Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3723722 Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS).] ''JAMA'' 256 (3):362-6. PMID: [http://pubmed.gov/3723722 3723722]</ref><ref name="pmid17976506">Syed FF, Mayosi BM (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17976506 A modern approach to tuberculous pericarditis.] ''Prog Cardiovasc Dis'' 50 (3):218-36. [http://dx.doi.org/10.1016/j.pcad.2007.03.002 DOI:10.1016/j.pcad.2007.03.002] PMID: [http://pubmed.gov/17976506 17976506]</ref> | ||
* | *Other causes of pericarditis, including bacterial and fungal infections, should be identified and treated accordingly. | ||
* | *Pericarditis due to [[lymphoma]]: | ||
:*[[Radiation]] and [[chemotherapy]] have been tried.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> <ref name="pmid17325873">Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17325873 Primary effusion lymphoma in pleural and pericardial cavities with multiple solid nodal and extra-nodal involvement in a human immunodeficiency virus-positive patient.] ''Leuk Lymphoma'' 48 (1):209-11. [http://dx.doi.org/10.1080/10428190601019880 DOI:10.1080/10428190601019880] PMID: [http://pubmed.gov/17325873 17325873]</ref> | :*[[Radiation]] and [[chemotherapy]] have been tried.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref><ref name="pmid17325873">Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17325873 Primary effusion lymphoma in pleural and pericardial cavities with multiple solid nodal and extra-nodal involvement in a human immunodeficiency virus-positive patient.] ''Leuk Lymphoma'' 48 (1):209-11. [http://dx.doi.org/10.1080/10428190601019880 DOI:10.1080/10428190601019880] PMID: [http://pubmed.gov/17325873 17325873]</ref> However, the response has been transient,<ref name="pmid9760158">Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9760158 Cardiac involvement in HIV-related non-Hodgkin's lymphoma: a case report and short review of the literature.] ''Ann Hematol'' 77 (1-2):75-8. PMID: [http://pubmed.gov/9760158 9760158]</ref> and the associated chemotherapy has significantly increased the risk of death secondary to [[opportunistic infection]]s.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> | ||
====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]] | *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]] levels.<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref> | ||
==References== | ==References== | ||
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[[Category:Inflammations]] | [[Category:Inflammations]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 18:02, 18 September 2017
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HIV induced pericarditis Microchapters |
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Differentiating HIV Induced Pericarditis from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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HIV induced pericarditis treatment On the Web |
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American Roentgen Ray Society Images of HIV induced pericarditis treatment |
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Risk calculators and risk factors for HIV induced pericarditis treatment |
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Pericarditis Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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HIV induced pericarditis treatment On the Web |
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American Roentgen Ray Society Images of HIV induced pericarditis treatment |
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Risk calculators and risk factors for HIV induced pericarditis treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; 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 occur in advanced stages of the disease or they signal the onset of full-blown AIDS. These asymptomatic effusions require treatment to improve survival.[1] HAART therapy has significantly reduced the incidence and severity of cardiac complications associated with HIV.[2][3]
- 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% of patients.[4]
- 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[5][6] or balloon pericardiotomy can be considered.[7][8]
- Large pericardial effusions with unknown etiology:
- Empiric antituberculous therapy for M.tuberculosis have shown some benefit in patients with AIDS.[9][10][11]
- Other causes of pericarditis, including bacterial and fungal infections, should be identified and treated accordingly.
- Pericarditis due to lymphoma:
- Radiation and chemotherapy have been tried.[12][13] However, the response has been transient,[14] and the associated chemotherapy has significantly increased the risk of death secondary to opportunistic infections.[12]
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 levels.[15]
References
- ↑ Barbaro G (2003) Pathogenesis of HIV-associated cardiovascular disease. Adv Cardiol 40 ():49-70. PMID: 14533546
- ↑ Ntsekhe M, Hakim J (2005) Impact of human immunodeficiency virus infection on cardiovascular disease in Africa. Circulation 112 (23):3602-7. DOI:10.1161/CIRCULATIONAHA.105.549220 PMID: 16330702
- ↑ Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF (2006) Cardiovascular disease in HIV infection. Am Heart J 151 (6):1147-55. DOI:10.1016/j.ahj.2005.07.030 PMID: 16781213
- ↑ 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. Am Heart J 137 (3):516-21. PMID: 10047635
- ↑ Flum DR, McGinn JT, Tyras DH (1995) The role of the 'pericardial window' in AIDS. Chest 107 (6):1522-5. PMID: 7781340
- ↑ Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998) Pericardial effusion and AIDS: benefits of surgical drainage. Eur J Cardiothorac Surg 13 (2):165-9. PMID: 9583822
- ↑ Ziskind AA, Pearce AC, Lemmon CC, Burstein S, Gimple LW, Herrmann HC et al. (1993) Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases. J Am Coll Cardiol 21 (1):1-5. PMID: 8417048
- ↑ Marcy PY, Bondiau PY, Brunner P (2005) Percutaneous treatment in patients presenting with malignant cardiac tamponade. Eur Radiol 15 (9):2000-9. DOI:10.1007/s00330-004-2611-y PMID: 15662494
- ↑ Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med 324 (5):289-94. DOI:10.1056/NEJM199101313240503 PMID: 1898769
- ↑ Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA 256 (3):362-6. PMID: 3723722
- ↑ Syed FF, Mayosi BM (2007) A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis 50 (3):218-36. DOI:10.1016/j.pcad.2007.03.002 PMID: 17976506
- ↑ 12.0 12.1 Levine AM (1992) AIDS-associated malignant lymphoma. Med Clin North Am 76 (1):253-68. PMID: 1727539
- ↑ Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) Primary effusion lymphoma in pleural and pericardial cavities with multiple solid nodal and extra-nodal involvement in a human immunodeficiency virus-positive patient. Leuk Lymphoma 48 (1):209-11. DOI:10.1080/10428190601019880 PMID: 17325873
- ↑ Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) Cardiac involvement in HIV-related non-Hodgkin's lymphoma: a case report and short review of the literature. Ann Hematol 77 (1-2):75-8. PMID: 9760158
- ↑ Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB; et al. (1995). "Pericardial effusion in AIDS. Incidence and survival". Circulation. 92 (11): 3229–34. PMID 7586308.