Immune reconstitution inflammatory syndrome and human immunodeficiency virus-associated myocarditis.
Myocarditis is a well-recognized cardiac manifestation of human immunodeficiency virus (HIV) infection, and alterations in the immune system likely play an important role in the pathogenesis of heart muscle disease in HIV-infected patients. Highly active antiretroviral therapy (HAART) has greatly improved survival in HIV patients but not without uncovering new and unique manifestations of disease. Immune reconstitution inflammatory syndrome is a collection of inflammatory disorders in which a pathologic inflammatory response and clinical deterioration occur during recovery of the immune system after HAART. To our knowledge, a correlation between immune reconstitution inflammatory syndrome and HIV-associated myocarditis has not been described previously. We report a case of acute myocarditis presenting with refractory ventricular arrhythmias in a patient with AIDS who experienced rapid immune recovery with the initiation of HAART. The case underscores the importance of recognizing this potential complication of AIDS treatment and calls for renewed vigilance concerning cardiac manifestations of HIV, especially during the immune reconstitution phase.
Rogers
Jonathan S
JS
Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Zakaria
Sammy
S
Thom
Kerry A
KA
Flammer
Kristin M
KM
Kanno
Mettassebia
M
Mehra
Mandeep R
MR
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002037:Bundle-Branch Block / Q000139:chemically induced; D004452:Echocardiography; D004562:Electrocardiography; D017809:Fatal Outcome; D006327:Heart Block / Q000139:chemically induced; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced*; D017563:Lung Diseases, Interstitial / Q000139:chemically induced; D008297:Male; D008944:Mitral Valve Insufficiency / Q000139:chemically induced; D009205:Myocarditis / Q000139:chemically induced*; D010490:Pericardial Effusion / Q000139:chemically induced; D013318:Stroke Volume / Q000502:physiology; D013616:Tachycardia, Sinus / Q000139:chemically induced; D017180:Tachycardia, Ventricular / Q000139:chemically induced*