INCIDENCE OF DILATED CARDIOMYOPATHY AND DETECTION OF HIV IN MYOCARDIAL-CELLS OF HIV-POSITIVE PATIENTS

Background Human immunodeficiency virus (HIV) infection is increasingl y recognized as an important cause of dilated cardiomyopathy. However, the pathogenesis of the heart-muscle disease in the acquired immunode ficiency syndrome is unclear. Methods We performed a prospective, long -term clinical and echocardiographic follow-up study of 952 asymptomat ic HIV-positive patients to assess the incidence of dilated cardiomyop athy and to analyze the clinical variables associated with the develop ment of cardiomyopathy. All patients with an echocardiographic diagnos is of dilated cardiomyopathy underwent endomyocardial biopsy for histo logic, immunohistologic, and virologic assessment. Results During a me an (+/-SD) follow-up period of 60+/-5.3 months, an echocardiographic d iagnosis of dilated cardiomyopathy was made in 76 patients (8 percent) , with a mean annual incidence rate of 15.9 cases per 1000 patients. T he incidence of dilated cardiomyopathy was higher in patients with a C D4 count of less than 400 cells per cubic millimeter (as compared with a CD4 count of greater than or equal to 400 cells per cubic millimete r) and in those who received therapy with zidovudine. A histologic dia gnosis of myocarditis was made in 63 of the patients with dilated card iomyopathy (83 percent). Inflammatory infiltrates were predominantly c omposed of CD3 and CD8 lymphocytes, with staining for major histocompa tibility complex class I antigens in 71 percent of the patients. In th e 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 coxsackiev irus group B (17 percent), 2 with cytomegalovirus (6 percent), and 1 w ith Epstein-Barr virus (3 percent). Conclusions Dilated cardiomyopathy may be related either to a direct action of HIV on the myocardial tis sue or to an autoimmune process induced by HIV, possibly in associatio n with other cardiotropic viruses. (N Engl J Med 1998;339:1093-9,) (C) 1998. Massachusetts Medical Society.