Although the diagnosis of
AIDS-associated
heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with
AIDS-associated
heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with
AIDS-associated
heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M.
tuberculosis (M. tb), cardiac
cryptococcosis, and Salmonella typhimurium. M. tb required emergency
pericardiectomy (well tolerated in all patients), then administration of
rifampin,
isoniazid, and
ethambutol.
Cryptococcosis was treated acutely with
amphotericin B and
flucytosine, then with maintenance
amphotericin B. The response, which included resolution of
congestive heart failure, occurred within a week. Salmonella
endocarditis was cured with administration of
ampicillin and
netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for
tuberculous pericarditis were somewhat lower than if the
tuberculosis was extracardiac (50% vs 67%). With cryptococcal
heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of
AIDS-associated
heart disease are often treatable. Although some cardiac
infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.