June 10, 2026European Heart Journal46 citations
Dilated heart muscle disease associated with HIV infection
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Key Result
Late-stage HIV infection (CD4 < 200 mm-3) was associated with the development of symptomatic heart disease in 9 of 174 (5.2%) prospectively followed patients.
Key Points
- This research aims to characterize the clinical features and risk factors associated with dilated heart muscle disease in HIV-infected patients.
- Prospective longitudinal study with 174 HIV-infected patients enrolled.
- Patients with CD4 T cell counts < 200 mm-3 were monitored for signs of cardiac dysfunction.
- Clinical characteristics and outcomes were assessed, particularly focusing on congestive heart failure and myocarditis.
- 9 patients developed symptomatic heart disease, with 7 cases of congestive heart failure.
- Doctors found that low CD4 T cell counts, myocarditis, and elevated anti-heart antibodies related to severe cardiac dysfunction.
- 84% of an additional 55 patients had New York Heart Association Class III or IV congestive heart failure.
Study Design
Type
Cohort (n=229)
Structured PICO
What are the clinical characteristics and risk factors associated with the development of dilated heart muscle disease in HIV-infected patients?
P
Population
174 HIV-infected patients in a prospective longitudinal study and 55 referred patients with global left ventricular dysfunction.
O
Outcome
Development of symptomatic heart disease (congestive heart failure, sudden cardiac death, cardiac tamponade) and clinical characteristics associated with severe symptomatic cardiac dysfunction.hard clinical
Severe HIV-related dilated heart muscle disease is a complication of late-stage HIV infection associated with low CD4 counts, myocarditis, and cardiac autoimmunity.
Limitations
- Need for long-term longitudinal studies of larger HIV-infected cohorts to identify specific risk factors
- Small sample size
- Larger long-term longitudinal studies are warranted
Abstract
As more effective therapies have produced longer survival times for HIV-infected patients, non-infectious complications of late stage HIV infection such as the development of severe global left ventricular dysfunction (dilated heart muscle disease) have emerged. The demographic and clinical characteristics of HIV-infected patients who develop dilated heart muscle disease as well as potential risk factors are, as yet, poorly characterized. Of 174 patients enrolled in a prospective longitudinal study, a total of nine patients, all with CD4 T cell counts < 200 mm-3, developed symptomatic heart disease (congestive heart failure n = 7, sudden cardiac death n = 1 and cardiac tamponade n = 1); three of these patients developed progressive cardiac dysfunction leading to primary cardiac failure and death. An additional 55 HIV-infected patients referred to our Cardiomyopathy Service were found to have global left ventricular dysfunction, with 84% having New York Heart Association Class III or IV congestive heart failure on presentation. Clinical characteristics associated with severe symptomatic cardiac dysfunction included low CD4 T cell counts, myocarditis associated with non-permissive cardiotropic virus infection on endomyocardial biopsy and persistent elevation of anti-heart antibodies. No relationships to any specific HIV risk factor or opportunistic infection were found. These findings suggest that a severe form of HIV-related dilated heart muscle disease is largely a disease of late stage HIV infection. Virus-related myocarditis and cardiac autoimmunity may play a role in the pathogenesis of progressive cardiac injury. Long-term longitudinal studies of larger HIV-infected cohorts are warranted to identify clinical, behavioral and immunologic risk factors.