Incidence of Dilated Cardiomyopathy and Detection of HIV in Myocardial Cells of HIV-Positive Patients
Giuseppe Barbaro, M.D., Gabriella Di Lorenzo, M.D., Benvenuto Grisorio, M.D., Giorgio Barbarini, M.D., for The Gruppo Italiano per lo Studio Cardiologico dei Pazienti Affetti da AIDS
Background Human immunodeficiency virus (HIV) infection is increasinglyrecognized as an important cause of dilated cardiomyopathy.However, the pathogenesis of the heart-muscle disease in theacquired immunodeficiency syndrome is unclear.
Methods We performed a prospective, long-term clinical and echocardiographicfollow-up study of 952 asymptomatic HIV-positive patients toassess the incidence of dilated cardiomyopathy and to analyzethe clinical variables associated with the development of cardiomyopathy.All patients with an echocardiographic diagnosis of dilatedcardiomyopathy underwent endomyocardial biopsy for histologic,immunohistologic, and virologic assessment.
Results During a mean (±SD) follow-up period of 60±5.3months, an echocardiographic diagnosis of dilated cardiomyopathywas made in 76 patients (8 percent), with a mean annual incidencerate of 15.9 cases per 1000 patients. The incidence of dilatedcardiomyopathy was higher in patients with a CD4 count of lessthan 400 cells per cubic millimeter (as compared with a CD4count of 400 cells per cubic millimeter) and in those who receivedtherapy with zidovudine. A histologic diagnosis of myocarditiswas made in 63 of the patients with dilated cardiomyopathy (83percent). Inflammatory infiltrates were predominantly composedof CD3 and CD8 lymphocytes, with staining for major histocompatibilitycomplex class I antigens in 71 percent of the patients. In themyocytes of 58 patients, HIV nucleic acid sequences were detectedby in situ hybridization, and active myocarditis was documentedin 36 of the 58. Among these 36 patients, 6 were also infectedwith coxsackievirus group B (17 percent), 2 with cytomegalovirus(6 percent), and 1 with Epstein–Barr virus (3 percent).
Conclusions Dilated cardiomyopathy may be related either toa direct action of HIV on the myocardial tissue or to an autoimmuneprocess induced by HIV, possibly in association with other cardiotropicviruses.
Source Information
From the Department of Emergency Medicine, University La Sapienza, Rome (G. Barbaro, G.D.); the Division of Infectious Diseases, General Hospital, Foggia (B.G.); and the Department of Infectious and Tropical Diseases, Policlinico S. Matteo, University of Pavia, Pavia (G. Barbarini) — all in Italy.
Address reprint requests to Dr. Barbaro at Viale Anicio Gallo 63, 00174 Rome, Italy.
Dilated Cardiomyopathy in HIV-Infected Patients
Chariot P., Perchet H., Monnet I., Malnick S., Goland S., Flotats A., Domingo P., Carrió I., Barbaro G., Barbarini G., Miller T. L., Lipshultz S. E.
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Full Text
N Engl J Med 1999;
340:732-735, Mar 4, 1999.
Correspondence
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A retraction has been published: N Engl J Med 2002;347(2):140.
400 cells per cubic millimeter) and in those who received therapy with zidovudine. A histologic diagnosis of myocarditis was made in 63 of the patients with dilated cardiomyopathy (83 percent). Inflammatory infiltrates were predominantly composed of CD3 and CD8 lymphocytes, with staining for major histocompatibility complex class I antigens in 71 percent of the patients. In the myocytes of 58 patients, HIV nucleic acid sequences were detected by in situ hybridization, and active myocarditis was documented in 36 of the 58. Among these 36 patients, 6 were also infected with coxsackievirus group B (17 percent), 2 with cytomegalovirus (6 percent), and 1 with Epstein–Barr virus (3 percent). 
