Dilated heart muscle disease associated with HIV infection

A. Herskowitz, S. B. Willoughby, D. Vlahov, K. L. Baughman, A. A. Ansari

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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 lending 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.

    Original languageEnglish (US)
    Pages (from-to)50-55
    Number of pages6
    JournalEuropean heart journal
    Volume16
    Issue numberSUPPL. O
    DOIs
    StatePublished - 1995

    Keywords

    • Acquired immunodeficiency syndrome
    • Cytomegalovirus
    • Dilated heart muscle disease
    • HIV
    • Myocarditis

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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