The impact of HIV co-infection on presentation and outcome in adults with tuberculous pericarditis: Findings from the IMPI trial

F Gumedze; S Pandie; J B Nachenga; Z Kerbelker; V Francis; L Thabane; M Smieja; J Bosch; S Yusuf; M Ntsekhe; G Meintjes; B M Mayosi

doi:10.7196/SAMJ.2023.v113i3b.16830

South African Medical Journal (Apr 2023)

The impact of HIV co-infection on presentation and outcome in adults with tuberculous pericarditis: Findings from the IMPI trial

F Gumedze,
S Pandie,
J B Nachenga,
Z Kerbelker,
V Francis,
L Thabane,
M Smieja,
J Bosch,
S Yusuf,
M Ntsekhe,
G Meintjes,
B M Mayosi

Affiliations

F Gumedze: Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
S Pandie: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
J B Nachenga: Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Z Kerbelker: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
V Francis: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
L Thabane: McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
M Smieja: McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
J Bosch: McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
S Yusuf: McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
M Ntsekhe: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
G Meintjes: Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
B M Mayosi: The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

DOI: https://doi.org/10.7196/SAMJ.2023.v113i3b.16830
Journal volume & issue: Vol. 13, no. 4b

Abstract

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Background. Little is known about the impact of HIV infection on clinical presentation, complications, and morbid pericarditis-related outcomes of tuberculous pericarditis and its predictors. Objective. To assess the impact of HIV infection on presentation and outcomes in the multicountry Investigation of the Management of Pericarditis (IMPI) randomised controlled trial of immunotherapy in tuberculous pericarditis conducted in sub-Saharan Africa. Methods. We compared clinical features and outcomes of 1 370 adult patients treated for tuberculous pericarditis (939 and 431 HIVinfected and uninfected, respectively) enrolled in the IMPI trial. Cox proportional hazards models were used to determine independent predictors of outcomes of HIV-associated tuberculous pericarditis. Results. At presentation, HIV-infected (v. uninfected) patients were younger (median age 34.0 years v. 47.7 years), had lower body mass (mean weight 56 kg v. 60 kg), higher prevalence of tachycardia (58.5% v. 51.9%), hypotension (9.4% v. 3.9%), anaemia (65.9% v. 26.8%), and radiographic pulmonary infiltrates compatible with tuberculosis (35.4% v. 27.4%), but had lower rates of peripheral oedema (37.1% v. 48.3%). HIV-infected (v. uninfected) patients were less likely to develop constrictive pericarditis (4.1% v. 10.0% at 1 year, p<0.0001 (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.27 - 0.63, p<0.0001)). However, there was no difference in case fatality rate at 1 year (14.9% v. 12.2%, respectively, p=0.09; (HR 1.20, 95%CI 0.90 - 1.59, p=0.22)). Among HIV-infected patients, heart failure New York Heart Association (NYHA) class III - IV, low body mass, hypotension, and peripheral oedema were independently associated with death. Conclusion. HIV infection alters the cardiovascular presentation and reduces the incidence of constrictive pericarditis, but does not increase case fatality. Mortality in HIV-infected patients is independently predicted by markers of pericardial and tuberculosis disease severity.

TB
HIV

Published in South African Medical Journal

ISSN: 0256-9574 (Print); 2078-5135 (Online)
Publisher: South African Medical Association
Country of publisher: South Africa
LCC subjects: Medicine: Medicine (General)
Website: https://samajournals.co.za/index.php/samj/index

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