HIV Infection Is Associated with a Lower Incidence of Constriction in Presumed Tuberculous Pericarditis: A Prospective Observational Study
Open Access
- 4 June 2008
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 3 (6), e2253
- https://doi.org/10.1371/journal.pone.0002253
Abstract
Pericardial constriction is a serious complication of tuberculous pericardial effusion that occurs in up to a quarter of patients despite anti-tuberculosis chemotherapy. The impact of human immunodeficiency virus (HIV) infection on the incidence of constrictive pericarditis following tuberculous pericardial effusion is unknown. We conducted a prospective observational study to determine the association between HIV infection and the incidence of constrictive pericarditis among 185 patients (median age 33 years) with suspected tuberculous pericardial effusion. These patients were recruited consecutively between March and October 2004 on commencement of anti-tuberculosis treatment, from 15 hospitals in Cameroon, Nigeria and South Africa. Surviving patients (N = 119) were assessed for clinical evidence of constrictive pericarditis at 3 and 6 months of follow-up. Clinical features of HIV infection were present in 42 (35.2%) of the 119 patients at enrolment into the study. 66 of the 119 (56.9%) patients consented to HIV testing at enrolment. During the 6 months of follow-up, a clinical diagnosis of constrictive pericarditis was made in 13 of the 119 patients (10.9 %, 95% confidence interval [CI] 5.9–18%). Patients with clinical features of HIV infection appear less likely to develop constriction than those without (4.8% versus 14.3%; P = 0.08). None of the 33 HIV seropositive patients developed constriction, but 8 (24.2%, 95%CI 11.1–42.3%) of the 33 HIV seronegative patients did (P = 0.005). In a multivariate logistic regression model adjusting simultaneously for several baseline characteristics, only clinical signs of HIV infection were significantly associated with a lower risk of constriction (odd ratio 0.14, 95% CI 0.02–0.87, P = 0.035). These data suggest that HIV infection is associated with a lower incidence of pericardial constriction in patients with presumed tuberculous pericarditis.This publication has 16 references indexed in Scilit:
- Contemporary use of adjunctive corticosteroids in tuberculous pericarditisInternational Journal of Cardiology, 2008
- Pericardial DiseaseCirculation, 2006
- The role of histopathology in establishing the diagnosis of tuberculous pericardial effusions in the presence of HIVHistopathology, 2006
- Tuberculous PericarditisCirculation, 2005
- Fibrotic disease and the TH1/TH2 paradigmNature Reviews Immunology, 2004
- Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patientsHeart, 2000
- Impact of HIV infection on tuberculosisPostgraduate Medical Journal, 2000
- Tuberculosis and HIV infection in sub-Saharan AfricaJAMA, 1992
- CONTROLLED CLINICAL TRIAL OF COMPLETE OPEN SURGICAL DRAINAGE AND OF PREDNISOLONE IN TREATMENT OF TUBERCULOUS PERICARDIAL EFFUSION IN TRANSKEIThe Lancet, 1988
- Tuberculous pericarditis in transkeiClinical Cardiology, 1984