Heart muscle disease related to HIV infection: prognostic implications.
OBJECTIVE
To determine the natural course of heart muscle disease in patients infected with HIV.


METHODS
Prospective echocardiographic survey and observational study over four years.


METHODS
Edinburgh.


METHODS
296 adults infected with HIV (mean age 32.7 years (range 21.5 to 67.6) drawn from all the major groups at risk of HIV infection in Britain.


METHODS
Detection of myocardial dysfunction and time to death from index echocardiogram in serial echocardiography.


RESULTS
Cardiac dysfunction was identified in 44 subjects (dilated cardiomyopathy, 13; isolated right ventricular dysfunction, 12; borderline left ventricular dysfunction, 19). Dilated cardiomyopathy was strongly associated with a CD4 cell count of < 100 x 10(6)/l, in contrast with the other forms of cardiac dysfunction. During the study 12/13 (92%) subjects with dilated cardiomyopathy, 5/12 (42%) with right ventricular dysfunction, and 8/19 (42%) with borderline left ventricular function died of conditions related to AIDS. Survival was significantly reduced in the subjects with dilated cardiomyopathy compared with those with normal hearts (P < 0.001). The median survival from the index echocardiogram was 101 days (95% confidence interval 42 to 146) for the subjects with cardiomyopathy compared with 472 days (383 to 560) for those with normal hearts and a CD4 cell count of < 20 x 10(6)/l. No significant difference existed in survival for subjects with borderline left or isolated right ventricular dysfunction.


CONCLUSIONS
Even after adjustment for the significantly reduced CD4 cell count with which dilated cardiomyopathy is associated, the outlook for patients with HIV infection and dilated cardiomyopathy is poor. Isolated right and borderline left ventricular dysfunction are not associated with reduced CD4 cells counts and do not carry adverse prognostic implications.
Currie
P F
PF
Department of Cardiology, Royal Infirmary, Edinburgh.
Jacob
A J
AJ
Foreman
A R
AR
Elton
R A
RA
Brettle
R P
RP
Boon
N A
NA
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000276:immunology; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000821:virology*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014463:Ultrasonography; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000401:mortality / Q000821:virology