Cardiac diseases in AIDS medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Medical Therapy
Majority of the AIDS patients with pericarditis are asymptomatic. Small pericardial effusions without tamponade can be followed up without any further testing. In symptomatic patients with large effusions with or without a tamponade, pericardiocentesis is indicated to obtain culture and cytology. If tamponade occurs, immediate drainage is necessary.
It is recommended that patients with pericarditis of unknown etiology be treated emperically for Mycobacterium tuberculosis. Addition of perdnisolone to anti-tubercular therapy is associated with rapid recovery, lower mortality rates and decreased need for surgical intervention.
Bacterial and fungal causes of pericarditis are treated with appropriate anti-bacterials and anti-fungals.
Pericarditis secondary to lymphoma can be treated with radiation and/or chemotherapy. However, combination chemotherapy has been shown to significantly increase the risk of early death from opportunistic infections.
Treatment of heart failure in patients with AIDS is similar to that of in general population. ACE inhibitors, diuretics, beta-blockers and digoxin are indicated as usual. Also, drugs that are known to cause cardiac side effects should be discontinued.
Lifestyle modification (smoking cessation, weight reduction) and control of hypertension, diabetes and elevated cholesterol should be paid special attention.