A patient infected with HIV may develop a dilated cardiomyopathy, which can be caused by a variety of conditions. Cardiomyopathy has become important with improved survival due to advances in antiretroviral therapy.


Clinical features:

(1) cardiomegaly with dilatation of all 4 cardiac chambers

(2) diffuse hypkinesis of the left ventricle

(3) decreased fractional shortening


Causes of a dilated cardiomyopathy in a patient with HIV disease:

(1) infectious myocarditis

(1a) HIV infection of myocytes

(1b) cytomegalovirus (CMV)

(1c) enterovirus

(1d) Epstein-Barr virus (EBV)

(1e) adenovirus

(1f) toxoplasmosis

(1g) mycobacteria

(1h) Cryptococcus and other fungal pathogens

(1i) Chagas disease

(2) toxic injury

(2a) antiretroviral therapy

(2b) cytokine-mediated myocyte injury (including tumor necrosis factor)

(2c) alcohol abuse

(2d) cocaine

(2e) methamphetamine

(3) ischemic injury secondary to coronary artery disease

(4) autoimmune disease including antiheart antibodies

(5) malnutrition including selenium and vitamin deficiencies

(6) endocrine disorder (hypothyroidism, hyperthyroidism, etc)


An endomyocardial biopsy can occasionally be helpful if the cause of the cardiomyopathy is uncertain.


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