For the integrated multidisciplinary approach to patient care

Return to the Southern Medical Journal

Current User S2 Access Level: -1 ()
CAN NOT ACCESS LEVEL 2

Reversible Right Ventricular Dysfunction in Patients with HIV Infection.

Umamahesh C. Rangasetty, MD, Atiar M. Rahman, MD, Nasir Hussain, MD
Volume: 99 Issue: 3 March, 2006

Abstract:

Human immunodeficiency virus-related cardiomyopathy is characterized by global left ventricular (LV) dysfunction commonly associated with biventricular dilation. Human immunodeficiency virus (HIV) cardiomyopathy carries a poor prognosis, and the role of antiretroviral therapy in the reversal of heart failure is not very clear. We report two patients with HIV infection who presented with severe right ventricular (RV) dysfunction in the absence of pulmonary parenchymal, pulmonary arterial and left ventricular myocardial involvement. During the period of intensive antiretroviral therapy, the symptoms of right heart failure progressively and remarkably improved. This was accompanied by normalization of right ventricular size and RV function documented by repeat echocardiograms. Given that the serologic tests for opportunistic infections were negative, and the RV function improvement correlated with a decrement in the viral load, it is likely that the cardiomyopathy was due to direct infection by HIV. These cases illustrate that there can be isolated involvement of the right heart in the absence of lung, significant pulmonary vascular and left ventricular disease, and also that the antiretroviral therapy might reverse the cardiomyopathy.


Key Points


* Isolated right heart failure can occur in patients with HIV infection due to cardiomyopathy.


* Reviewing the patient’s history is very important in the diagnostic evaluation of patients.


* Treatment with antiretroviral therapy might reverse human immunodeficiency virus-associated cardiomyopathy.

Article:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Images:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

References:

1. De Castro S, Migliau G, Silvestri A, et al. Heart involvement in AIDS: a prospective study at various stages of the disease. Eur Heart J 1992;13:1452–1459.
 
2. Currie PF, Jacob AJ, Foreman AR, et al. Heart muscle disease related to HIV infection: prognostic implications. BMJ 1994;309:1605–1607.
 
3. Himelman RB, Chung WS, Chernoff DN, et al. Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study. J Am Coll Cardiol 1989;13:1030–1036.
 
4. Prendergast BD. HIV and cardiovascular medicine. Heart 2003;89:793–800.
 
5. Rerkpattanapipat P, Wongpraparut N, Jacobs LE, et al. Cardiac manifestations of acquired immunodeficiency syndrome. Arch Intern Med 2000;160:602–608.
 
6. Cohen IS, Anderson DW, Vermani R, et al. Congestive cardiomyopathy in association with the acquired immunodeficiency syndrome. N Engl J Med 1986;315:628–630.
 
7. Barbaro G, Fisher SD, Lipshultz SE. Pathogenesis of HIV associated cardiovascular complications.Lancet Infect Dis 2001;1:115–124.
 
8. Barbaro G. Cardiovascular manifestation of HIV infection. Circulation 2002;106:1420–1425.
 
9. Lewis W. Cardiomyopathy in AIDS: a pathophysiological perspective. Prog Cardiovasc Dis 2000; 43:151–170.
 
10. Kannmogne GD. Noninfectious pulmonary complications of HIV/AIDS. Curr Opin Pulm Med2005;11:208–212.
 
11. Kanmogne GD, Kennedy RC, Grammas P. Is HIV involved in the pathogenesis of non-infectious pulmonary complications in infected patients? Curr HIV Res 2003;1:385–393.
 
12. Speich R, Jenni R, Opravil M, et al. Regression of HIV-associated pulmonary arterial hypertension and long-term survival during antiretroviral therapy. Swiss Med Wkly 2001;131:663–665.
 
13. Zuber JP, Calmy A, Evison JM, et al. Pulmonary arterial hypertension related to HIV infection: improved hemodynamics and survival associated with antiretroviral therapy. Clin Infect Dis2004;38:1178–1185.
 
14. Klings ES, Farber HW. The pathogenesis of HIV-associated pulmonary hypertension. Adv Cardiol2003;40:71–82.
 
15. Pellicelli AM, D’Ambrosio C, Vizza CD, et al. HIV-related pulmonary hypertension: from pathogenesis to clinical aspects. Acta Cardiol 2004;59:323–330.
 
16. Pugliese A, Isnardi D, Saini A, et al. Impact of highly active antiretroviral therapy in HIV-positive patients with cardiac involvement. J Infect 2000;40:282–284.
 
17. Lipshultz SE, Orav EJ, Sanders SP, et al. Immunoglobulins and left ventricular structure and function in pediatric HIV infection. Circulation 1995;92:2220–2225.
 
18. Wilkins CE, Sexton JD, McAllister HA. HIV-associated myocarditis treated with zidovudine (AZT).Texas Heart Inst J 1989;16:44–45.
 
19. Tayal SC, Ghosh SK, Reaich D. Asymptomatic HIV patient with cardiomyopathy and nephropathy: case report and literature review. J Infect 2001;42:288–290.
 
20. Fingerhood M. Full recovery from severe dilated cardiomyopathy in an HIV-infected patient. AIDS Read 2001;11:333–335.
 
21. Diogenes MS, Carvalho AC, Succi RC. Reversible cardiomyopathy subsequent to perinatal infection with the human immunodeficiency virus. Cardiol Young 2003;13:373–376.
 
22. Tanuma J, Ishizaki A, Gatanaga H, et al. Dilated cardiomyopathy in an adult human immunodeficiency virus type 1-positivepatient treated with a zidovudine-containing antiretroviral regimen.Clin Infect Dis 2003;37:e109–111.
 

CME:

Portions of this issue may be available for CME credit. Please email education@sma.org for a complete listing of current Southern Medical Journal activities, as well as other SMA educational offerings.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Permissions