Dilated heart muscle disease associated with HIV infection.
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 characteristics 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 III 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.
Herskowitz
A
A
Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA.
Willoughby
S B
SB
Vlahov
D
D
Baughman
K L
KL
Ansari
A A
AA
D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002305:Cardiac Tamponade / Q000473:pathology; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000473:pathology; D004699:Endocardium / Q000276:immunology / Q000473:pathology; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
D001323:Autoantibodies