Heart muscle disease was found in 14.2% of HIV patients and took three principal forms - dilated cardiomyopathy, borderline left ventricular dysfunction and isolated right ventricular dilation. Dilated cardiomyopathy was associated significantly with a very low CD4 count indicative of late stage HIV disease. It was invariably irreversible. In contrast, some patients with borderline left ventricular dysfunction and isolated right ventricular dilation subsequently reverted to normal. The latter was usually related to pressure or volume overload of the right ventricle rather than to a primary myopathic process. Survival curves were calculated and these showed that HIV patients with dilated cardiomyopathy met a significantly earlier death from an AIDS related condition than those from all the other groups, even after accounting for their low CD4 count. This remained true when patients with dilated cardiomyopathy were matched individually with a group of patients identical in every respect except for the presence of cardiac disease. Heart muscle disease in HIV infection is common and takes a number of forms. Dilated cardiomyopathy occurs in late stage disease, is invariably irreversible and is associated with a particularly poor prognosis. This is in contrast to borderline left ventricular dysfunction and isolated right ventricular dilation which occur at an earlier stage of HIV infection, are potentially reversible and do not carry adverse prognostic implications. Neither infection with Toxoplasma gondii and cytomegalovirus nor treatment with zidovudine appear to have a primary role in the development of heart muscle disease. Although HIV is often found within the myocardium, it does not appear to replicate within this tissue. Low serum selenium concentrations are widespread in HIV patients but do not correlate with cardiac dysfunction.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:652913 |
| Date | January 1995 |
| Creators | Jacob, Ashok J. |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/20587 |
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