Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Dilated heart muscle disease associated with HIV infection
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* The Johns Hopkins University School of Medicine, Department of Medicine, Division of Cardiology Atlanta, Georgia, U.S.A.
The Johns Hopkins University School of Public Health and Hygiene, Department of Immunology and Infectious Disease Atlanta, Georgia, U.S.A.
Department of Epideiology Baltimore, Maryland
¶ Department of Pathology, Emory University Medical Centre, Winship Cancer Center Atlanta, Georgia, U.S.A.
Ahvie Herskowitz, MD. The Johns Hopkins School of Public Health and Hygiene. Department of Molecular Microbiology and Immunology. 615 North Wolfe Street, Room 5017. Baltimore, Maryland 21205 U.S.A.
As more effective therapies have produced longer survival times for HIV-infected patients, non-infectious complications of late stage HIV infection such as the development of severe global left ventricular dysfunction (dilated heart muscle disease) have emerged. The demographic and clinical characteristcs of HIV-infected patients who develop dilated heart muscle disease as well as potential risk factors are, as yet, poorly characterized. Of 174 patients enrolled in a prospective longitudinal study, a total of nine patients, all with CD4 T cell counts <200 mm-3, developed symptomatic heart disease (congestive heart failure n = 7, sudden cardiac death n = 1 and cardiac tamponade n = 1); three of these patients developed progressive cardiac dysfunction leading to primary cardiac failure and death. An additional 55 HIV-infected patients referred to our Cardiomyopathy Service were found to have global left ventricular dysfunction, with 84% having New York Heart Association Class 111 or IV congestive heart failure on presentation. Clinical characteristics associated with severe symptomatic cardiac dysfunction included low CD4 T cell counts, myocarditis associated with non-permissive cardiotropic virus infection on endomyocardial biopsy and persistent elevation of anti-heart antibodies. No relationships to any specific HIV risk factor or opportunistic infection were found. These findings suggest that a severe form of HIV-related dilated heart muscle disease is largely a disease of late stage HIV infection. Virus-related myocarditis and cardiac autoimmunity may play a role in the pathogenesis of progressive cardiac injury. Long- term longitudinal studies of larger HIV-infected cohorts are warranted to identify clinical, behavioral and immunologic risk factors.
Key Words: HIV • dilated heart muscle disease • acquired immunodeficiency syndrome • myocarditis • cytomegalovirus