AIDS and the heart: Clinicopathologic assessment

Acquired immune deficiency syndrome (AIDS) is responsible for significant morbidity and mortality in the United States and other countries. Cardiac involvement in AIDS, which was previously felt to be an unusual manifestation of the disease, is now being described with increasing frequency. Clinical and necropsy studies have demonstrated myocarditis, myocardial necrosis, cardiomyopathy, pericardial disease, endocarditis, pulmonary hypertension, and tumor infiltration in patients dying with AIDS. A direct role for human immunodeficiency virus (HIV-1) in the development of myocarditis, myocardopathy, and pericardial disease has not yet been elucidated. Recent immunopathological evidence suggests 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 mitochondrial changes in myocardial muscle. There are also suggestions that the cardiac complications of AIDS are different in patients whose risk factor for HIV infection is homosexual practice compared with patients 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 who are intravenous drug abusers.