Pericardial Effusion

Before the introduction of HAART, the preva­lence of pericardial effusion in asymptomatic AIDS patients was estimated at 11% per year [19]. Although prospective data are lacking, retrospective data suggest that HAART has reduced the overall incidence of pericardial effusion in HIV disease by about 30% [24] (Fig.

A 5-year prospective evaluation of car­diac involvement in AIDS found 16 of 231 patients had or developed pericardial effu­sions [19]. Three subjects had an effusion on enrollment, and 13 developed effusions dur­ing follow-up (12/13 with AIDS at enroll­ment). Pericardial effusions were generally small (80%) and asymptomatic (87%). The calculated incidence of pericardial effusion among those with AIDS was 11% per year. The prevalence of effusion in AIDS patients may rise over time, reaching an estimated mean of 22% after 25 months of follow-up in asymptomatic patients [19].

Among subjects with AIDS and pericar­dial effusion, 36% were alive after 6 months of follow-up, whereas 93% of those without effusion were alive at 6 months [19]. Two patients developed pericardial tamponade as assessed by clinical and echocardiographic criteria [19]. Several studies have suggested spontaneous resolu­tion of pericardial effusion over time in 13-42% of affected patients [19]. However, mortality remains markedly increased in patients who had developed an effusion, whether or not the effusion resolved [19].

Fig. 7 Prevalence of HIV-associated pericardial effusion in the years 1995-2005. The vertical line indicates the introduction of HAART in the treatment of HIV infection