Congestive Heart Failure

In HIV-infected patients, symptoms of heart failure may be masked by concomitant ill­ness such as diarrhea or malnutrition, or may be disguised by bronchopulmonary infection. Left ventricular asynergy may develop due to regional differences in the distribution of cardiac sympathetic nerve endings, even in the context of acute myocarditis.

Fig. 3 CT scan finding of a large and circumferential pericardial effusion in an HIV-infected pa­tient with Mycobacterium M. tu­berculosis infection

Standard heart failure treatment regi­mens are generally recommended for HIV- infected patients with dilated cardiomyopa­thy and congestive heart failure, even though these regimens have not been tested in this specific population. Patients with systolic dysfunction and symptoms of fluid retention should receive a loop diuretic and an aldosterone antagonist as well as an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors are recommended on the basis of general heart failure studies, but may be poorly tolerated due to low sys­temic vascular resistance from diarrheal disease, infection, or dehydration. Digoxin may be added to the therapy regimen of patients with persistent symptoms or rapid atrial fibrillation. When the patient is euv- olemic, a β-blocker (e.g., carvedilol, meto­prolol, and bisoprolol) may be started because of its beneficial effects on circulat­ing levels of inflammatory and anti-inflam­matory cytokines.