Cardiomyopathy means heart disease of unknown cause. One form of cardiomyopathy called dilated cardiomyopathy, is characterised by poor contraction of the heart muscles. Recent reports have found that people with HIV have a high rate of dilated cardiomyopathy and that HIV may be a cause of that condition.

Dilated cardiomyopathy is suggestive of a poorer prognosis among people with HIV disease. HIV-infected people also have higher than average rates of left ventricular hypertrophy - a condition where the heart swells to compensate for its increasing weakness.

Regular heart and lung check-ups may allow early diagnosis and treatment of heart conditions.

Mechanism and risk factors

The role HIV plays in the development of heart disease is not understood. It may directly impact on heart cells, or induce disease through the dysregulation of the immune system or coinfection with other viruses. Poor nutrition and wasting may also contribute to heart disease, and anecdotal reports have suggested that antiretroviral therapy including protease inhibitors may increase a person's risk of heart disease.

Key research

Barbaro undertook a long-term, prospective study to assess the incidence of dilated cardiomyopathy among people with HIV and to analyse clinical factors influencing its development. 952 HIV-positive people were followed for an average of 60 months. 76 (8%) were diagnosed with dilated cardiomyopathy, of whom 63 also had myocarditis (inflammation of the muscle in the heart wall). Researchers did not determine the causal mechanism but suggested two possibilities: the direct action of HIV on the heart, or an autoimmune process induced by HIV, possibly in conjunction with other viruses such as EBV or CMV.

References

Barbaro G et al. Incidence of dilated cardiomyopathy and detection of HIV in myocardial cells of HIV-positive patients. Gruppo Italiano per lo studio cardiologico dei pazienti affetti da AIDS. New England Journal of Medicine 339(16): 1093-1099, 1998.

Lipshultz SE. Dilated cardiomyopathy in HIV-infected patients. New England Journal of Medicine 339(16): 1153-1155, 1998.