BMJ 1994;309:1605-1607 (17 December)

Papers

Heart muscle disease related to HIV infection: prognostic implications

Peter F Currie, junior research fellow,,a Ashok J Jacob, registrar,,a Angus R Foreman, data manager,,b Robert A Elton, senior lecturer,c Ray P Brettle, consultant physician,b Nicholas A Boon, consultant cardiologist a

a Department of Cardiology, Royal Infirmary, Edinburgh EH3 9YW, British Heart Foundation,, b Regional Infectious Disease Unit, City Hospital, Edinburgh EH10 5SB,, c Medical Statistics Unit, University of Edinburgh, Edinburgh EH8 9AG,

Correspondence to: Dr P F Currie.

Abstract

Objectives: To determine the natural course of heart muscle disease in patients infected with HIV.
Design: Prospective echocardiographic survey and observational study over four years.
Setting: Edinburgh. Subjects--296 adults infected with HIV (mean age 32.7 years (range 21.5 to 67.6) drawn from all the major groups at risk of HIV infection in Britain.
Main outcome measures: Detection of myocardial dysfunction and time to death from index echocardiogram in serial echocardiography.
Results: Cardiac dysfunction was identified in 44 subjects (dilated cardiomyopathy, 13; isolated right ventricular dysfunction, 12; borderline left ventricular dysfunction, 19). Dilated cardiomyopathy was strongly associated with a CD4 cell count of <100 x 106/l, in contrast with the other forms of cardiac dysfunction. During the study 12/13 (92%) subjects with dilated cardiomyopathy, 5/12 (42%) with right ventricular dysfunction, and 8/19 (42%) with borderline left ventricular function died of conditions related to AIDS. Survival was significantly reduced in the subjects with dilated cardiomyopathy compared with those with normal hearts (P<0.001). The median survival from the index echocardiogram was 101 days (95% confidence interval 42 to 146) for the subjects with cardiomyopathy compared with 472 days (383 to 560) for those with normal hearts and a CD4 cell count of <20 x 106/l. No significant difference existed in survival for subjects with borderline left or isolated right ventricular dysfunction.
Conclusion: Even after adjustment for the significantly reduced CD4 cell count with which dilated cardiomyopathy is associated, the outlook for patients with HIV infection and dilated cardiomyopathy is poor. Isolated right and borderline left ventricular dysfunction are not associated with reduced CD4 cells counts and do not carry adverse prognostic implications.

Key messages

  • Key messages

  • The cardiac manifestations of AIDS are well recognised and will probably become more common as the treatment of opportunistic infections improves

  • Although anecdotal reports suggest that patients with HIV related dilated cardiomyopathy have a poor prognosis, this has not been established in a formal survival study

  • This study confirms the prevalence of heart muscle disease related to HIV infection and shows that patients with dilated cardiomyopathy have a poor outlook

  • Other recent work has shown that the CD4 cell count cannot alone predict the outcome in patients with AIDS; conditions such as dilated cardiomyopathy will become important prognostic indicators


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