AIDS AND THE HEART - CLINICOPATHOLOGICAL ASSESSMENT

Acquired immune deficiency syndrome (AIDS) is responsible for signific ant morbidity and mortality in the United States and other countries. Cardiac involvement in AIDS, which was previously felt to be an unusua l manifestation of the disease, is now being described with increasing frequency. Clinical and necropsy studies have demonstrated myocarditi s, myocardial necrosis, cardiomyopathy, pericardial disease, endocardi tis, pulmonary hypertension, and tumor infiltration in patients dying with AIDS. A direct role for human immunodeficiency virus (HIV-1) in t he development of myocarditis, myocardopathy, and pericardial disease has not yet been elucidated. Recent immunopathological evidence sugges ts a possible role for immune-mediated myocardial inflammatory changes . The drugs used to treat HIV-1 have not been shown to be cardiotoxic; however, there are suggestions that azidothymidine (AZT) can cause mi tochondrial changes in myocardial muscle. There are also suggestions t hat the cardiac complications of AIDS are different in patients whose risk factor for HIV infection is homosexual practice compared with pat ients having intravenous drug addiction as their major risk factor for HIV disease. Risk factors for myocardial disease, other than HIV, may also be contributors to cardiac complications in patients with AIDS w ho are intravenous drug abusers.