Heart involvement in AIDS: a prospective study during various stages of the disease

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Abstract
The goal of our study was to evaluate the incidence of heart involvement in AIDS patients during various stages of the disease. Between January 1988 to September 1991, we conducted a prospective study in 114 anti-HIV positive patients. The patients, whose mean age ( ± SD) was 34·6 ± 5·4 years (range 20 to 54), were divided into three groups: anti-HIV positive asymptomatic (n = 31; 27%), AIDS related complex (ARC) group IV-A (n=11; 10%), and AIDS subgroups IV-C1 (n = 62; 54%) and IV-D (n=10;9%). Overall, 84 patients (74%) were i.v. drug abusers, 24 (21%) were homosexuals, and six (5%) were partners at risk. Zidovudine (AZT) was administered to 94 patients (82%). Opportunistic infections and/or secondary malignancies were detected in 72 patients (63%). Electrocardiographic changes were of little clinical relevance. Of 72 AIDS patients, 47 (65·2%) presented a cardiac involvement: 12 subjects (16·6%) were affected by a dilated cardiomyopathy, 13 (18%) by pericardial effusion, three (4·1%) by mitral valve prolapse, four (5·5%) by myocarditis, five (6·9%) by valvular bacterial endocarditis, and 10 (13·8%) by alterations of left ventricle regional contractility. During a mean follow-up period of 44 months, 29 AIDS patients (40·2%) died. Death was attributed to a cardiac event in four patients; autopsy could be performed in 24 of the 29 patients who died. Our results demonstrate that heart involvement is present in 45·6% of HIV-infected patients, but only in the end-stage of the disease (AIDS) and it is presumably due to opportunistic infections and/or secondary malignancies. The direct role of HIV in the genesis of cardiomyopathy remains uncertain and will be evaluated by further studies.

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