In reply to Dr Cheng's comments (April 2002 JRSM1) I do not question the therapeutic role of selenium supplementation in patients with malnutrition (including selenium deficiency) and dilated cardiomyopathy in those with Keshan disease. However, the role of selenium deficiency in HIV-infected patients with cardiomyopathy is still controversial and controlled prospective clinical trials in this subset of patients are lacking. Cardiac and pulmonary complications of HIV disease are generally late manifestations and may be related to prolonged effects of immunosuppression and a complex interplay of mediator effects from opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiotoxicity and nutritional deficiencies (selenium, vitamin B12, carnitine, growth hormone and thyroid hormone, frequently in combination)2,3. Because of its multifactorial pathogenesis, HIV-associated cardiomyopathy should not be compared to Keshan disease, since they are independent nosological entities from both a pathogenetic and a clinical point of view.
References
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