HEART-MUSCLE DISEASE-RELATED TO HIV-INFECTION - PROGNOSTIC IMPLICATIONS

Objectives-To determine the natural course of heart muscle disease in patients infected with HIV. Design-Prospective echocardiographic surve y and observational study over four years. Setting-Edinburgh. Subjects -296 adults infected with HIV (mean age 32.7 years (range 21.5 to 67.6 ) drawn from all the major groups at risk of HIV infection in Britain. Main outcome measures-Detection of myocardial dysfunction and time to death from index echocardiogram in serial echocardiography. Results-C ardiac dysfunction was identified in 44 subjects (dilated cardiomyopat hy, 13; isolated right ventricular dysfunction, 12; borderline left ve ntricular dysfunction, 19). Dilated cardiomyopathy was strongly associ ated with a CD4 cell count of < 100x10(6)/1, in contrast with the othe r forms of cardiac dysfunction. During the study 12/13 (92%) subjects with dilated cardiomyopathy, 5/12 (42%) with right ventricular dysfunc tion, and 8/19 (42%) with borderline left ventricular function died of conditions related to AIDS. Survival was significantly reduced in the subjects with dilated cardiomyopathy compared with those with normal hearts (P < 0.001). The median survival from the index echocardiogram was 101 days (95% confidence interval 42 to 146) for the subjects with cardiomyopathy compared with 472 days (383 to 560) for those with nor mal hearts and a CD4 cell count of < 20x10(6)/1. No significant differ ence existed in survival for subjects with borderline left or isolated right ventricular dysfunction. Conclusion-Even after adjustment for t he significantly reduced CD4 cell count with which dilated cardiomyopa thy is associated, the outlook for patients with HIV infection and dil ated cardiomyopathy is poor. Isolated right and borderline left ventri cular dysfunction are not associated with reduced CD4 cells counts and do not carry adverse prognostic implications.