Human immunodeficiency virus-associated pericardial effusion: Report of 40cases and review of the literature

Background Human immunoficiency virus [HIV] -associated pericardial effusio n is common. We present its clinical Features, cause, and prognosis on the basis of a review of 40 cases at a single public hospital. Methods A retrospective study was conducted of 122 patients with pericardia l effusion (of which 40 were HIV associated) admitted to Queens Hospital Ce nter from January 1988 to April 1997 A review of the literature is also pre sented. Results Forty patients with HIV-associated pericardial effusion represent 3 3% of the 122 patients with pericardial effusion admitted during that perio d, The most common symptom of the 40 patients was dyspnea (75%). Echocardio gram detected small effusions in 18 (45%), moderate effusions in 10 (25%), and large effusions in 12 (30%). Sixteen (40%) patients had cardiac tampona de, in 15 of whom pericardiocentesis or pericardiostomy was performed. Caus es of cardiac tamponade were Mycobacterium species in 3 (19%), Streptococcu s pneumoniae in 1 (6%), Staphylococcus aureus in 1 (6%), Kaposi's sarcoma i n 1 (6%), and unknown in 10 (63%). In comparison, causes of cardiac tampona de in 74 cases of acquired immunodeficiency syndrome in the literature were 45% idiopathic, 20% mycobacteria, 19% bacteria, 7% lymphoma, 5% Kaposi's s arcoma, 3% viruses, and 1% fungus. Thirteen of the 40 patients were lost to follow-vp. Among the other 27, 11 (41%) were alive at 3 months and 5(19%) at 1 year. Ten of the 27 patients had cardiac tamponade, of whom 5 (50%) we re alive at 3 months and 3 (30%) at 1 year. Conclusions HIV-associated pericardial effusion is the most common type of pericardial effusion in our inner city hospital, Causes are diverse. The de velopment of pericardial effusion predicts a poor prognosis in HIV infectio n.