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Heart muscle disease related to HIV infection: prognostic implications
P F Currie1, A J Jacob, A R Foreman
1Department of Cardiology, Royal Infirmary, Edinburgh.
Insights
HIV-associated dilated cardiomyopathy significantly worsens prognosis, with a poor outlook even after adjusting for low CD4 counts. Other cardiac dysfunctions in HIV patients do not appear to impact survival.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Heart muscle disease is a concern in individuals with Human Immunodeficiency Virus (HIV) infection.
- Understanding the natural course of cardiac dysfunction in HIV is crucial for patient management.
Purpose of the Study:
- To investigate the long-term outcomes of different types of heart muscle disease in patients with HIV.
- To assess the prognostic implications of cardiac dysfunction in the context of HIV infection.
Main Methods:
- A prospective echocardiographic survey and observational study was conducted over four years in Edinburgh.
- 296 adults with HIV were monitored for myocardial dysfunction and survival.
- Serial echocardiography was used to detect cardiac dysfunction and track time to death.
Main Results:
- Cardiac dysfunction was found in 44 participants: 13 with dilated cardiomyopathy, 12 with isolated right ventricular dysfunction, and 19 with borderline left ventricular dysfunction.
- Dilated cardiomyopathy was strongly linked to a CD4 cell count below 100 x 10(6)/l.
- Survival was significantly reduced in patients with dilated cardiomyopathy (median survival 101 days) compared to those with normal hearts and low CD4 counts (median survival 472 days).
- 92% of patients with dilated cardiomyopathy died from AIDS-related conditions, versus 42% for right ventricular dysfunction and 42% for borderline left ventricular dysfunction.
Conclusions:
- HIV-infected patients with dilated cardiomyopathy face a poor prognosis, independent of CD4 cell count.
- Isolated right ventricular dysfunction and borderline left ventricular dysfunction in HIV patients do not appear to carry adverse prognostic implications.
- Early detection and management of cardiac dysfunction in HIV are essential, particularly dilated cardiomyopathy.
Objectives:
To determine the natural course of heart muscle disease in patients infected with HIV.
Design:
Prospective echocardiographic survey and observational study over four years.
Setting:
Edinburgh.
Subjects:
296 adults infected with HIV (mean age 32.7 years (range 21.5 to 67.6) drawn from all the major groups at risk of HIV infection in Britain.
Main Outcome Measures:
Detection of myocardial dysfunction and time to death from index echocardiogram in serial echocardiography.
Results:
Cardiac dysfunction was identified in 44 subjects (dilated cardiomyopathy, 13; isolated right ventricular dysfunction, 12; borderline left ventricular dysfunction, 19). Dilated cardiomyopathy was strongly associated with a CD4 cell count of < 100 x 10(6)/l, in contrast with the other forms of cardiac dysfunction. During the study 12/13 (92%) subjects with dilated cardiomyopathy, 5/12 (42%) with right ventricular dysfunction, and 8/19 (42%) with borderline left ventricular function died of conditions related to AIDS. Survival was significantly reduced in the subjects with dilated cardiomyopathy compared with those with normal hearts (P < 0.001). The median survival from the index echocardiogram was 101 days (95% confidence interval 42 to 146) for the subjects with cardiomyopathy compared with 472 days (383 to 560) for those with normal hearts and a CD4 cell count of < 20 x 10(6)/l. No significant difference existed in survival for subjects with borderline left or isolated right ventricular dysfunction.
Conclusion:
Even after adjustment for the significantly reduced CD4 cell count with which dilated cardiomyopathy is associated, the outlook for patients with HIV infection and dilated cardiomyopathy is poor. Isolated right and borderline left ventricular dysfunction are not associated with reduced CD4 cells counts and do not carry adverse prognostic implications.