CARDIAC INVOLVEMENT IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME - A REVIEW TO PUSH ACTION

As more effective therapies have produced longer survival times for hu man immunodeficiency virus (HIV)-infected patients, new complications of late-stage HIV infection including HIV-related heart disease have e merged. Almost any agent that can cause disseminated infection in pati ents with acquired immunodeficiency syndrome (AIDS) may involve myocar dium, but clinical evidence of cardiac disease is usually overshadowed by manifestations in other organs, primarily the brain and lungs. Car diac abnormalities are found at autopsy in two-thirds of patients with AIDS, and more than 150 reports of cardiac complications have been pu blished. Cardiac involvement in HIV disease includes pericardial effus ion, myocarditis, dilated cardiomyopathy, and/or endocardial involveme nt at any stage of the disease. This review deals with all the cardiac manifestations of AIDS and serves to highlight two problems and one i ndication. First of all, there are very few clinical studies. Current knowledge is based almost exclusively on echocardiography and autopsy studies. Observational or clinical trials would be useful. Second, the re exists very poor information on the impact of treatment; and epidem iologic and clinicopathologic studies are mandatory for obtaining deta iled data concerning the mechanisms of myocardial damage in AIDS. Fina lly, because cardiac complications are often clinically inapparent or subtle in the initial stages, periodic screening of HIV-positive patie nts by electrocardiogram and echocardiogram is probably indicated. In addition, AIDS may also provide the opportunity to gain insights into the pathogenesis of little understood cardiac diseases such as lymphoc ytic myocarditis and dilated cardiomyopathy.