title: Myocarditis and cardiotropic viral infection associated with severe left ventricular dysfunction in late-stage infection with human immunodeficiency virus.
abstract: OBJECTIVE
  The purpose of this study was to characterize the histologic and immunopathologic results of 37 endomyocardial biopsy samples from patients infected with human immunodeficiency virus type 1 (HIV-1) who were evaluated for unexplained global left ventricular dysfunction.
  
  
  BACKGROUND
  Recent studies have identified a growing number of patients infected with HIV-1 who develop unexplained left ventricular dysfunction and congestive heart failure. Myocarditis has been confirmed at autopsy in small numbers of such patients, although a pathogenic opportunistic infectious agent can rarely be identified.
  
  
  METHODS
  All patients had moderate to severe global left ventricular hypokinesia on two-dimensional echocardiography. Endomyocardial biopsy samples were evaluated by standard histologic studies, immunoperoxidase staining and in situ hybridization for cytomegalovirus and HIV-1 gene sequences.
  
  
  RESULTS
  Twenty-eight patients presented with New York Heart Association functional class III or IV congestive heart failure. Four patients had myocarditis secondary to known etiologies (opportunistic infection n = 2; drug-induced hypersensitivity myocarditis n = 2). Of the remaining 33 samples, 17 (51%) showed histologic evidence of idiopathic active or borderline myocarditis. Immunohistologic findings revealed induced expression of major histocompatibility class I antigen on myocytes and increased numbers of infiltrating CD8+ T lymphocytes. Specific hybridization within myocytes was observed in 5 of 33 samples with the HIV-1 antisense riboprobe and in 16 of 33 samples with the cytomegalovirus immediate early (IE-2) antisense riboprobe. All but one patient with specific myocyte hybridization presented with congestive heart failure; all patients had myocarditis and CD4+ cell counts < 100/mm3.
  
  
  CONCLUSIONS
  This study demonstrates that cardiotropic virus infection and myocarditis may be important in the pathogenesis of symptomatic HIV-associated cardiomyopathy.
authors.affiliation: Department of Medicine, School of Public Health and Hygiene, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: A
authors.initials: A
authors.lastname: Herskowitz
authors.forename: T C
authors.initials: TC
authors.lastname: Wu
authors.forename: S B
authors.initials: SB
authors.lastname: Willoughby
authors.forename: D
authors.initials: D
authors.lastname: Vlahov
authors.forename: A A
authors.initials: AA
authors.lastname: Ansari
authors.forename: W E
authors.initials: WE
authors.lastname: Beschorner
authors.forename: K L
authors.initials: KL
authors.lastname: Baughman
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000473:pathology; D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000473:pathology; D004452:Echocardiography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000473:pathology