Based on the additional information from your institution,1 we agree that pericardial effusion is one of the most common cardiac manifestations of acquired immunodeficiency syndrome. In most patients with HIV, the effusions are small and most patients are asymptomatic.2 In the series by Chen et al,1 the incidence of large pericardial effusion was high (30%) and most of the patients were symptomatic: dyspnea, 75%; tachycardia, 43%; increased jugular venous pressure, 30%; paradoxical pulse, 20%; and edema, 23%. Because cardiac and/or pulmonary symptoms are more likely to be investigated with the use of echocardiography, larger pericardial effusions are more likely to be detected. Heidenreich et al2 reported that the presence of pericardial effusion in patients with the acquired immunodeficiency syndrome was associated with poor prognosis, but the size of the pericardial effusion was not. The mean CD4 cell count in patients with HIV with pericardial effusion was lower than in patients without effusion.1,2 The mere presence of pericardial effusion in patients with HIV might be regarded as a marker of end-stage HIV infection; however, in most patients, it rarely causes death.3 Patients with HIV who present with cardiac and/or pulmonary symptoms should be evaluated for cardiac and/or pulmonary causes as described in our article.3 If large pericardial effusions are detected, these patients should be followed up closely, and in those patients who develop cardiac tamponade, pericardial drainage should be undertaken. Once the origin of the pericardial effusion has been determined, specific therapy should be instituted. With this approach symptoms should be alleviated, but it is unclear whether survival in this group of patients will be dramatically prolonged.
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