(86) Biventricular Heart Failure and Severe Tricuspid Regurgitation in an HIV-Positive Patient with Pulmonary Hypertension and Pericardial Effusion: A case report

Clinical Scenario or Case: A 36-year-old male had a past medical history of cavitary lesion in left upper lung with interval disappearance 10 years without evidence of tuberculosis or neoplasm on biopsy. He was diagnosed syphilis, genital herpes, HIV infected 5 years ago, and received treatment at the time of diagnosis, but unknown follow-up as well as poor ART adherence for two years. He presented irritated mood, fatigue, chronic shortness of breath, orthopnea, and abdominal pain. ECG showed normal sinus rhythm, tachycardia with non-specific ST-T changes. Echocardiogram revealed reduced LVEF 30-35%, small to moderate pericardial effusion with no signs of cardiac tamponade, RV severe dilation, very severe TR with RVSP 58 mmHg, severe pulmonary hypertension. We excluded PE via chest CT angiogram and negative coronary artery obstructions via coronary angiogram. Abdomen CT angiogram showed fatty hepatomegaly, ascites, mesenteric and retroperitoneal lymphadenopathy. Patient was placed on medications for his heart failure and PH management. He was also reconnected with HIV care center for taking ART. Cardiothoracic surgery consultation recommended that patient be transferred to tertiary care center for evaluation of TR repair, either with TriClip or surgical intervention.

Evidence/Literature Review: HIV-associated cardiomyopathy is thought to be multifactorial, including ART-induced, immunologic mechanisms, or HIV-induced myocardial injury associated with opportunistic infections. However, the mechanisms are uncertain. There are many cohort studies documented a developed dilated cardiomyopathy in asymptomatic HIV-positive individuals, which can lead to significant disease burden without treatment. Chronic inflammation, co-infections, and immune dysregulation may exacerbate myocardial damage in these populations.

Unique Aspects of Case: The case highlights HIV-related cardiomyopathy and pulmonary hypertension. Multidisciplinary approach is vital in complex cases overlapping infectious and cardiovascular disease.

Recommendations/Conclusions: Cardiac complications relate to HIV infection, including HF, chronic pericardial effusion, severe tricuspid regurgitation, and PH. ART nonadherence might contribute to rapid cardiovascular deterioration. Coordination of multidisciplinary care is essential for long-term management, especially in underserved populations.