Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;21(7):465–472. doi: 10.1002/clc.4960210704

Cardiac involvement in acquired immunodeficiency syndrome—a review to push action

JosÉ Mllei 1,✉, Daniel Grana 2, Graciela Fernández Alonso 3, Luigi Matturri 4
PMCID: PMC6656289  PMID: 9669054

Abstract

As more effective therapies have produced longer survival times for human immunodeficiency virus (HIV)‐infected patients, new complications of late‐stage HIV infection including HIV‐related heart disease have emerged. Almost any agent that can cause disseminated infection in patients with acquired immunodeficiency syndrome (AIDS) may involve myocardium, but clinical evidence of cardiac disease is usually overshadowed by manifestations in other organs, primarily the brain and lungs. Cardiac abnormalities are found at autopsy in two‐thirds of patients with AIDS, and more than 150 reports of cardiac complications have been published. Cardiac involvement in HIV disease includes pericardial effusion, myocarditis, dilated cardiomyopathy, and/or endocardial involvement at any stage of the disease. This review deals with all the cardiac manifestations of AIDS and serves to highlight two problems and one indication. First of all, there are very few clinical studies. Current knowledge is based almost exclusively on echocardiography and autopsy studies. Observational or clinical trials would be useful. Second, there exists very poor information on the impact of treatment; and epidemiologic and clinicopathologic studies are mandatory for obtaining detailed data concerning the mechanisms of myocardial damage in AIDS. Finally, because cardiac complications are often clinically inapparent or subtle in the initial stages, periodic screening of HIV‐positive patients by electrocardiogram and echocardiogram is probably indicated. in addition, AIDS may also provide the opportunity to gain insights into the pathogenesis of little understood cardiac diseases such as lymphocytic myocarditis and dilated cardiomyopathy.

Keywords: acquired immunodeficiency syndrome, myocarditis, cardiomyopathy, human immunodeficiency virus, myocardial dysfunction

Full Text

The Full Text of this article is available as a PDF (956.2 KB).

References

  • 1. Anonymous : Mortality attributable to HIV infection/AlDS in the USA, 1981‐1990. MMWR 1991; 40: 41–44 [PubMed] [Google Scholar]
  • 2. Schulhafer EP, Verma RS: Acquired immunodeficiency syndrome: Molecular biology and its therapeutic intervention. In Viva 1989; 3: 61–78 [PubMed] [Google Scholar]
  • 3. Buhler JA, Schneider J: Heart and AIDS. Schweiz Med! Wochenschr/J Suisse Med 1994; 124: 1326–1333 [PubMed] [Google Scholar]
  • 4. Kaul S, Fishbein MC, Siegel RJ: Cardiac manifestations of acquired immune deficiency syndrome: A 1991 update Am Heart J 1991; 122: 535–544 [DOI] [PubMed] [Google Scholar]
  • 5. Milei J: Young labs (South American) associates to old tradition (Italian) in cardiovascular pathology. Candiovasc Pathol 1997; 6: 299 [Google Scholar]
  • 6. Falus JD: Los inhibidores de proteasa: Un paso crítico en el tratamiento de VIH. Medico Interamericano 1996; 15: 233–258 [Google Scholar]
  • 7. Anonymous : Major advances in the treatment of HIV‐1 infection Drug Ther Bull 1997; 35: 25–29 [DOI] [PubMed] [Google Scholar]
  • 8. Enger C, Graham N, Peng Y, Chmiel JS, Kingsley LA, Detels R, Muńoz A: Survival from early, intermediate, and late stages of HIV infection. J Am Med Assoc 1996; 275: 1329–1334 [PubMed] [Google Scholar]
  • 9. Monsuez JJ, Vittecoci D, Kinney EL: Increased survival of AIDS patients with heart disease within 10 years? Circulation 1996; 94: 2312–2313 [PubMed] [Google Scholar]
  • 10. Mocroft A, Youle M, Morcinek J, Sabin CA, Gazzard B, Johnson MA, Phillips AN: Survival after diagnosis of AIDS: A prospective observational study of 2625 patients. Br Med J 1997; 314: 409–413 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Herskowitz A, Choou Wu T, Willoughby SB, Vlahov D, Anasari AA, Beschorner WE, Baughman KL: Myocarditis and cardiotropic viral infection associated with severe left ventricular dysfunction in late‐stage infection with human immunodeficiency virus. J Am Coll Cardiol 1994; 24: 1025–1032 [DOI] [PubMed] [Google Scholar]
  • 12. Izquierdo Patron M, La Fuente C, Haro Estarriol M, Arevalo González M: Sinus bradycardia secondary to systemic pentamidine. Rev Esp Cardiol 1996; 49: 919–920 [PubMed] [Google Scholar]
  • 13. Cardoso JS, Mota Miranda A, Conde C, Moura B, Rocha Goncalves F, Lecour H: Int J Cardiol 1997; 59: 285–289 [DOI] [PubMed] [Google Scholar]
  • 14. Herskowitz A: Cardiomyopathy and other symptomatic heart diseases associated with HIV infection. Curr Opin Cardiol 1996; 11: 325–331 [DOI] [PubMed] [Google Scholar]
  • 15. Jacob AJ, Sutherland GR, Bird AG, Brettle RP, Ludlam CA, McMillan A, Boon NA: Myocardial dysfunction in patients infected with HIV: Prevalence and risk factors. Br Heart J 1992; 68: 549–553 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Voytek TM, Joshi V: Cardiac pathology of pediatric HIV infection. Prog Pediatr Cardiol 1997; 7: 7–18 [Google Scholar]
  • 17. Cotton P: AIDS giving rise to cardiac problems. J Am Med Assoc 1990; 263: 2149 [PubMed] [Google Scholar]
  • 18. Anderson DW, Virmani R: Emerging patterns of heart disease in human immunodeficiency virus infection. Hum Pathol 1990; 21: 253–259 [DOI] [PubMed] [Google Scholar]
  • 19. Weniger BC, Brown R: The march of AIDS through Asia. N Engl J Med 1996; 335: 343–344 [DOI] [PubMed] [Google Scholar]
  • 20. Kaplan S: Evolving epidemiology ofhuman immunodeficiency viral (HIV) infection. Prog Pediatr Cardiol 1997; 7: 1–6 [Google Scholar]
  • 21. Herskowitz A, Willoughby SB, Vlahov D, Baughman KL, Ansari AA: Dilated heart muscle disease associated with HIV infection. Eur Heart J 1995; 16: (suppl O) 50–55 [DOI] [PubMed] [Google Scholar]
  • 22. Roldan EO, Moskowitz L, Hensley GT: Pathology of the heart in acquired immunodeficiency syndrome. Arch Pathol Lab Med 1987; 111: 943–946 [PubMed] [Google Scholar]
  • 23. Patel RC, Frishman W: Cardiac involvement in HIV infection. Med Clin North Am 1996; 80: 1493–1512 [DOI] [PubMed] [Google Scholar]
  • 24. Thuesen L, Moller A: Heart involvement in HIV infection. Nord Med 1994; 109: 298–299 [PubMed] [Google Scholar]
  • 25. Aftabuddin M, Islam N, Alimuzzaman M, Koiralla TR, Hori Y: Cardiac malignant lymphoma in severe combine iminunodeficient mice. Indian Heart J 1996; 48: 368–370 [PubMed] [Google Scholar]
  • 26. Denis J, Hery B, Crepin V, Guillemot L, Guerzider P: Malignant tumoral lymphoma of the heart in human immunodeficiency virus infection: Diagnosis by echocardiography. Arch Mai Coeur Vaiss 1995; 88: 507–510 [PubMed] [Google Scholar]
  • 27. Francis CK: Cardiac involvement in AIDS. Curr Probl Cardiol 1990; 15: 569–639 [DOI] [PubMed] [Google Scholar]
  • 28. Feneley MP: Managing HIV. Part 5: Treating secondary outcomes. 5.9 HIV‐related cardiovascular disease. Med J Aust 1996; 164: 482 [PubMed] [Google Scholar]
  • 29. Guillemot L, Denis J, Caille G, Migeon J, Nouel JF, Linder F: Xray computed tomographic diagnosis of primary cardiac malignant lymphoma in AIDS. J Radial 1996; 77: 45–48 [PubMed] [Google Scholar]
  • 30. Nyamathi A: AIDS‐related heart disease: A review of the literature. J Cardiovasc Nurs 1989; 3: 65–76 [DOI] [PubMed] [Google Scholar]
  • 31. De Castro S, Migliau G, Silvestri A, D'Amati G, Giannantoni P, Cartoni D, Kol A, Vullo V, Cirelli A: Heart involvement in AIDS: A prospective study during various stages of the disease. Eur Heart J 1992; 13: 1452–1459 [DOI] [PubMed] [Google Scholar]
  • 32. Longo Mbenza B, Tonduangu K, Muvova D, Phuati MB, Seghers KV, Kestelot H: A clinical study of cardiac manifestations related to AIDS in Kinsaha. Arch Mal Coeur Vaiss 1995; 88: 1437–1443 [PubMed] [Google Scholar]
  • 33. Barbara G, Barbarini G, Di Lorenzo G: Early impairment of systolic and diastolic function in asymptomatic HIV‐positive patients: A multicenter echocardiographic and echo‐Doppler study. The Gruppo Italiano Per Io Studio Cardiologico dei Pazienti Affetti da AIDS. AIDS Res Hum Retroviruses 1996; 12: 155–1563 [DOI] [PubMed] [Google Scholar]
  • 34. Casalino E, Laissy JP, Soyer P, Bouvet E, Vachon F: Assessment of right ventricle function and pulmonary artery circulation by cineMRI in patients with AIDS. Chest 1996; 110: 1243–1247 [DOI] [PubMed] [Google Scholar]
  • 35. Coudray N, de Zuttere D, Force G, Champetier de Ribes D, Poumy JC, Antony I, Lecarpentier Y, Chimla D: Left ventricular diastolic function in asymptomatic and symptomatic human immunodeficiency virus carriers: An echocardiographic study. Eur Heart J 1995; 16: 61–67 [DOI] [PubMed] [Google Scholar]
  • 36. Kinney EL, Brafman D, Wright RJ: Echocardiographic findings in patients with acquired immunodeficiency syndrome (AIDS) and AIDS‐related complex (ARC). Cathet Cardiovasc Diagn 1989; 16: 182–185 [DOI] [PubMed] [Google Scholar]
  • 37. Lassaigne D, Greder A, Hedoire F, Grollier G, Potier JC, Bazin C: Myocardial involvement in AIDS. Echographic study in 85 human immunodeficiency virus infected patients. Ann Med Interne Paris 1991; 142: 205–208 [PubMed] [Google Scholar]
  • 38. Akhras F, Dubrey S, Gazzard B, Noble MI: Emerging patterns of heart disease in HIV infected homosexual subjects with and without opportunistic infections: A prospective colour flow Doppler echocardiographic study. Eur Heart J 1994; 15: 68–75 [DOI] [PubMed] [Google Scholar]
  • 39. Gouello JP, Chennebault JM, Loison J, Bovachour G, Tirot P, Achard J: Echocardiographic abnormalities in the stage IV of HIV infection. Presse Medic 1993; 22: 712–716 [PubMed] [Google Scholar]
  • 40. Hakim JG, Matenga JA, Siziya S: Myocardial dysfunction in human immunodeficiency virus infection: An echocardiographic study of 157 patients in hospital in Zimbawe. Heart 1996; 76: 161–165 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41. Stare T: Heart failure and cardiac disease in children with HIV infection. Prog Pediatr Cardiol 1997; 7: 45–50 [Google Scholar]
  • 42. al Kassab AK, Habte Gabr E, Mueller WF, Azher Q: Fulminant disseminated toxoplasmosis in an HIV patient. Scand J Infect Dis 1995; 27: 183–185 [DOI] [PubMed] [Google Scholar]
  • 43. Mertens RB, Didier ES, Fishbein MC, Bertucci DC, Rogers LB, Orenstein JM: Encephalitozoon cuniculi microsporidiosis; Infection of the brain, heart, kidneys, trachea, adrenal glands, and urinary bladder in a patient with AIDS. Mod Pathol 1997; 10: 68–77 [PubMed] [Google Scholar]
  • 44. Yachnis AT, Berg J, Martinez Salazar A, Bender BS, Diaz L, Rojiani AM, Eskin TA, Orenstein JM: Disseminated microsporidiosis especially infecting the brain, heart, and kidneys. Report of a newly recognized pansporoblastic species in two symptomatic AIDS patients. Am J Clin Pathol 1996; 106: 535–543 [DOI] [PubMed] [Google Scholar]
  • 45. Escamilla R, Hermant C, Petureau F, Voigt JJ, Krempf M: Disseminated aspergillosis with pulmonary and cardiac localization in an HIV‐infected patient. Rev Mal Respir 1995; 12: 380–382 [PubMed] [Google Scholar]
  • 46. Lewis W: AIDS: Cardiac findings from 115 autopsies. Prog Cardiovasc Dis 1989; 32: 207–215 [DOI] [PubMed] [Google Scholar]
  • 47. Eisenberg MJ, Gordon AS, Schiller NB: HIV‐associated pericardial effusions. Chest 1992; 102: 95–958 [DOI] [PubMed] [Google Scholar]
  • 48. Heidenreich PA, Eisenberg MJ, Kee LL: Pericardial effusions in AIDS. Incidence and survival. Circulation 1995; 92: 3229–3234 [DOI] [PubMed] [Google Scholar]
  • 49. Moreno R, Villacastin JP, Bueno H, López de Sa E, López Sendón JL, Bobadilla JF, Garcia Fernández MA, Delcan JL: Clinical and echocardiographic findings in HIV patients with pericardial effusion. Cardiology 1997; 88: 397–400 [DOI] [PubMed] [Google Scholar]
  • 50. Kovacs A, Hinton DR, Wright D, Xu J, Rasheed S, Hofman F: Human immunodeficiency virus type 1 infection of the heart in three infants with acquired immunodeficiency syndrome and sudden death. Pediatr Infect Dis J 1996; 15: 819–824 [DOI] [PubMed] [Google Scholar]
  • 51. Flomenbaum M, Soeiro R, Udem SA, Kress Y, Factor SM: Proliferative membranopathy and human immunodeficiency virus in AIDS hearts. J AIDS 1989; 2: 129–135 [PubMed] [Google Scholar]
  • 52. Grody WW, Cheng L, Lewis W: Infection of the heart by the human immunodeficiency virus. Am J Cordial 1990; 66: 203–206 [DOI] [PubMed] [Google Scholar]
  • 53. Wink K, Schmitz H: Cytomegalovirus myocarditis. Am Heart J 1980; 100: 667–672 [DOI] [PubMed] [Google Scholar]
  • 54. Wilson R, Morris T, Rossel RJR: Cytomegalovirus myocarditis. Br Heart J 1982; 34: 856–858 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55. Barbaro G, DiLorenzo G, Grisorio B, Barbarini G: Clinical meaning of ventricular ectopic beats in the diagnosis of HIV‐related myocarditis: A retrospective analysis of Holler electrocardiographic recordings, echocardiographic parameters, histopathological and virologic findings. Cardiologia 1996; 41: 1199–1207 [PubMed] [Google Scholar]
  • 56. Anderson DW, Virmani R, Reilly JM, O'Leary T, Cunnion RE, Robinowitz M, Macher AM, Punja U, Villaflor ST, Parrillo JE, et al.: Prevalent myocarditis at necropsy in the acquired immunodeficiency syndrome. J Am Coll Cardiol 1988; 11: 792–799 [DOI] [PubMed] [Google Scholar]
  • 57. Rodriguez ER. Nasim S, Hsia J, Sandin RL, Ferreira A, Milliard BA, Ross AM, Garrett CT: Cardiac myocytes and dendritic cells harbor human immunodeficiency virus in infected patients with and without cardiac dysfunction: Detection by multiplex, nested, polymerase chain reaction in individually microdissected cells from right ventricular endomyocardial biopsy tissue. Am J Cardiol 1991; 68: 1511–1520 [DOI] [PubMed] [Google Scholar]
  • 58. Hansen BF: Pathology of the heart in AIDS. A study of 60 consecutive autopsies. APMIS 1992; 100: 273–279 [DOI] [PubMed] [Google Scholar]
  • 59. Parravicini C, Baroldi G, Gaiera G, Lazzarin A: Phenotype of intramyocardial leukocytic infiltrates in acquired immunodeficiency syndrome: A postmortem immunohislochemical study in 34 consecutive cases. Mod Pathol 1991; 4: 559–565 [PubMed] [Google Scholar]
  • 60. Matturri L, Quattrone P, Varesi C, Rossi L: Cardiac toxoplasmosis in pathology of acquired immunodeficiency syndrome. Panminerva Med 1990; 32: 194–196 [PubMed] [Google Scholar]
  • 61. Kaminski HJ, Katzman M, Wiest PM, Gifford DR, Rackley R, Iskandar SS, Lederman MM: Cardiomyopathy associated with the acquired immune deficiency syndrome. J Acquir Immune Defic Syndr 1988; 1: 105–110 [PubMed] [Google Scholar]
  • 62. Cetta F, Michels VV: The natural history and spectrum of idiopathic dilated cardiomyopathy, including HIV and periparlum cardiomyopathy. Curr Opin Curdiol 1995; 10: 332–338 [DOI] [PubMed] [Google Scholar]
  • 63. Webb JG, Chan Yan C, Kiess MC: Cardiac dysfunction associated with the acquired immunodeficiency syndrome (AIDS). Clin Canliol 1988; 11: 423–426 [DOI] [PubMed] [Google Scholar]
  • 64. Currie PF, Jacob AJ, Foreman AR, Elton RA, Breltle RP, Boon NA: Heart muscle disease related to HIV infection: Prognostic implications. Br Med J 1994; 309: 1605–1607 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65. Bagasra O, Bobroski LE, Pestaner JP, Seshamma T, Pomerantz RJ: Localization of HIV‐1 in cardiac tissue utilizing in situ PCR. Cell Vision 1996; 3: 6–10 [Google Scholar]
  • 66. Calabrese LH, Proffitt MR, Yen Lieberman B, Hobbs RE, Ratliff NB: Congestive cardiomyopathy and illnes related to the acquired immunodeficiency syndrome (AIDS) associated with isolation of retrovirús from myocardium. Ann Intern Med 1987; 107: 691–692 [DOI] [PubMed] [Google Scholar]
  • 67. Dworkin BM, Antonecchia PP, Smith F: Reduced cardiac selenium content in AIDS. J Parent Ent Nutr 1989; 13: 644–647 [DOI] [PubMed] [Google Scholar]
  • 68. Domanski MJ, Sloas MM, Follmann DA: Effect of zidovudine and didanosine treatment on heart function in children infected with human immu nodeficiency virus. J Pediatr 1995; 127: 137–146 [DOI] [PubMed] [Google Scholar]
  • 69. Beschomer WE, Baughman K, Turnicky RP: HIV‐associated myocarditis. Pathology and immunopathology. Am J Pathol 1990; 137: 1365–1371 [PMC free article] [PubMed] [Google Scholar]
  • 70. Jaques AK, Arroja I, Araujo C, Azevedo J, Borges A, Santos I, Cabral A, Campos MJ, Masinho K, Borges F: Sindrome de inmunodeficiencia adquirida, miocardiopatia hipertrofica e endocardite infecciosa multivalvular. Aproposito de um caso clinico. Rev Port Curdiol 1995; 14: 53–58 [PubMed] [Google Scholar]
  • 71. Fernandez Guerrero ML, Torres Perea R. Gomez Rodrigo J, Nunez Garcia A, Jusdado JJ, Ramos Rincon JM: Infectious endocarditis due to non‐typhi salmonella in patients infected with human immunodeficiency virus: Report of two cases and review. Clin Inject Dis 1996; 22: 853–855 [DOI] [PubMed] [Google Scholar]
  • 72. Kinney EL, Monsuez JJ, Kitzis M, Vittecoq D: Treatment of AIDS associated heart disease. Angiology 1989; 40: 970–976 [DOI] [PubMed] [Google Scholar]
  • 73. Hecht SR, Berger M, Van Tosh A, Croxson S: Unsuspected cardiac abnormalities in the AIDS. An echocardiographic study. Chest 1989; 96: 805–808 [DOI] [PubMed] [Google Scholar]
  • 74. Corallo S, Mutinelli M, Moroni M, Lazzarin A, Celano V, Repossini A, Baroldi G: Echocardiography detects myocardial damage in AIDS: Prospective study in 102 patients. Eur Heart J 1988; 9: 887–892 [DOI] [PubMed] [Google Scholar]
  • 75. Lipshultz SE, Chanock S, Sanders SP, Colan SD, Perez Atayde A, Mclntosh K: Cardiovascular manifestations of human immunodeficiency virus infection in infants and children. Am J Cardiol 1989; 63: 1489–1497 [DOI] [PubMed] [Google Scholar]
  • 76. Paton P, Tabib A, Loire R, Tete R: Coronary artery lesions and human immunodeficiency virus infection. Res Virol 1993; 144: 225–231 [DOI] [PubMed] [Google Scholar]
  • 77. Ferraris VJ, Roberts WC: Myocardial biopsy: A useful diagnostic procedure or only a research tool? Am J Canliol 1978; 41: 965–967 [DOI] [PubMed] [Google Scholar]
  • 78. Mason JW, O'Connell JB: Clinical merit of endomyocardial biopsy. Circulation 1989; 79: 971–979 [DOI] [PubMed] [Google Scholar]
  • 79. Milei J, Bortman G, Fernández Alonso G, Grancellli H, Beigelrnan R: Immunohistochemical staining of lymphocytes for the reliable diagnosis of myocarditis in endomyocardial biopsies. Cardiology 1990; 77: 77–85 [DOI] [PubMed] [Google Scholar]
  • 80. Milei J, Fernandez Alonso JG, Vanzulli S, Storinio R, Matturri L, Rossi L: Myocardial inflammatory infiltrate in human chronic Chagasic cardiomyopathy: Immunohistochemical findings. Car diovasc Pathol 1996; 5: 209–219 [DOI] [PubMed] [Google Scholar]
  • 81. Barbeau P, Pellegrin JL, Labouyne E, Brassard G, Rispal P, Lasseur C, Leng B: Intérêt el limites de la biopsie endomyocardique an cours de 1'infection par le VIH. Rev Med Interne 1993; 14: 1032 [DOI] [PubMed] [Google Scholar]
  • 82. Cenacchi G, Re MC, Furlini G, La Placa M, Binetti G, Rapezi C, Alampi G, Magnani B: Human immunodeficiency virus type 1 antigen detection in endomyocardial biopsy: An immunopathological study. Microbiologica 1990; 13: 145–149 [PubMed] [Google Scholar]
  • 83. Girgis I, Gualberti J, Langan L, Malek S, Mustaciuolo V, Costantino T, McGinn TO: A prospective study of the effect of IV pentamidine therapy on ventricular arrhythmias and QTc prolongation in HIV‐intected patients. Chest 1997; 112: 646–653 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES