The detection of viral genomes by polymerase chain reaction in the myocardium of pediatric patients with advanced HIV disease

OBJECTIVES The aim of this study was to investigate the frequency of viral nucleic acid detection in the myocardium of human immunodeficiency virus (H IV)-infected children to determine whether an association exists with the d evelopment of heart disease. BACKGROUND As improved medical interventions increase the life expectancy o f HIV-infected patients, increased incidences of myocarditis and dilated ca rdiomyopathy (DCM) are becoming more apparent, even in patients without cli nical symptoms. METHODS Myocardial samples were obtained from the postmortem hearts of 32 H IV-infected children and from 32 age-matched controls consisting of patient s with structural congenital heart disease and no myocardial inflammation a nd no cardiac or systemic Viral infection. The hearts were examined histolo gically and analyzed for the presence of viral sequences by polymerase chai n reaction (PCR) or reverse transcription-PCR, RESULTS Myocarditis was detected histologically in 11 of the 32 HIV-infecte d patients, and borderline myocarditis was diagnosed in another 13 cases. I nfiltrates were confined to the epicardium in two additional hearts. Virus sequences were detected by PCR in 11 of these 26 cases (42.3%); adenovirus in 6, CMV in 3 and both adenovirus and CMV in 2. Two cases without infiltra tes were also positive for adenovirus: one had congestive heart failure (CH F) and the other adenoviral pneumonia. No other viruses were detected by PC R, including HIV proviral DNA. All control samples were negative for all vi ruses tested. CONCLUSION These data suggest that the presence of viral nucleic acid in th e myocardium is common in HIV-infected children, and may relate to the deve lopment of myocarditis, DCM or CHF and may contribute to the rapid progress ion of HIV disease. (J Am Coil Cardiol 1999;34: 857-65) (C) 1999 by the Ame rican College of Cardiology.