Background: Several gains have been made against the HIV pandemic, but the menace remains far from over as we continue to encounter it in various clinical situations. HIV infection poses a many-fold challenge in medical therapeutics. By its immunomodulating effect, it creates atypical presentations, makes patients prone to a wide range of infectious etiologies and blunts response to treatment thus altering the course of the natural history.
Methods: A retrospective cohort study was designed using data obtained from the 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age >18) with principal diagnosis of acute pericarditis were identified using the international diseases classification code, tenth revision (ICD-10), and placed into two groups based on presence of HIV as a secondary diagnosis. Primary outcomes evaluated were, mortality, length of stay (LOS) and total hospital charge. Secondary outcomes included pericardial effusion, cardiac tamponade, cardiogenic shock, and rate of pericardial window. Multivariate linear and logistic regressions were used to adjust for confounders.
Results: There was a total of 36,570 adult hospitalizations for acute pericarditis, out of which 0.71% had associated secondary diagnosis of HIV. The presence of HIV diagnosis was associated with an increase length of stay, (5.19days vs 3.63 days, adjusted mean difference: 1.56 days, 95%CI : 1.18 – 2.94, p- 0.027). There was an associated increase in total charge with a charge difference of 14,147 USD but this difference did not meet statistical significance. Mortality rate between the two groups was the same, at 0.088%. There was no statistical difference between patients with HIV and those without in terms of all secondary outcomes evaluated including, pericardial effusion, cardiac tamponade, cardiogenic shock, and rate of pericardial window.
Conclusions: Presence of HIV diagnosis led to an increase in length of stay but this did not translate to increase in mortality or significant difference in total charge among patients admitted with acute pericarditis. There was also no difference in clinical outcomes between the two groups. It will be worth pursuing further studies to determine if these findings are hinged on the level of HIV disease control or not.