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Myocardial disease in human immunodeficiency virus (HIV) infection: a review

HIV und Erkrankungen des Myokards

  • Review Article
  • Published:
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Zusammenfassung

Die Erkrankung des Herzmuskels ist die wichtigste kardiovaskuläre Manifestation einer HIV Infektion. Mit Zunahme der Lebenserwartung der Patienten wird ihre Prävalenz wahrscheinlich zunehmen. Sie kann sich als Myokarditis, als dilatative Kardiomyopathie, oder als isolierte Dysfunktion des linken oder rechten Ventrikels manifestieren. Die myokardiale Beteiligung bei einer HIV Infektion ist multifaktoriell: Sie kann eine Folge der myokardialen Invasion mit HIV selbst sein, aber auch auf Grund von opportunistischen Infekten, Virusinfektionen, autoimmunen Reaktionen auf eine Virusinfektion, einer medikamentös bedingten Kardiotoxizität, Unterernährung, sowie als Folge der lang andauernden Immunsuppression entstehen. Sowohl Kinder als auch Erwachsene sind betroffen. Der Schweregrad des myokardialen Befalls reicht vom autoptischen Zufallsbefund mikroskopisch sichtbarer myokardialer Entzündung bis zur klinisch wirksamen Herzerkrankung mit chronischer kardialer Funktionsstörung. Die Prognose ist schlecht und resultiert bei 5% aller HIV Patienten im symptomatischen Herzversagen. Studien aus der Zeit vor der Einführung der hoch aktiven antiretroviralen Therapie (HAART) zeigen eine ungefähr 30%ige Prävalenz einer Kardiomyopathie bei Patienten mit AIDS. Die HAART hat den Verlauf der HIV-Erkrankung deutlich verändert: die Überlebenszeit wurde verlängert und die Lebensqualität der mit HIV infizierten Patienten wurde verbessert. Gute Evidenz deutet darauf hin, dass die HAART auch das Vorkommen der kardiovaskulären Manifestationen einer HIV Infektion significant reduziert. Im Vergleich zur "Prä-HAART-Ära" wurde die Prävalenz der HIV assoziierten Kardiomyopathie durch HAART um fast das 7-fache reduziert. Dies wird als Folge der Vermeidung von opportunistischen Infektionen und der Reduktion des Auftretens einer Myokarditis aufgefasst. Die HAART steht allerdings nur einer Minderheit der mit HIV infizierten Individuen zur Verfügung. In den meisten Gebieten der Welt gelten heute noch die in der "Prä-HAART-Ära" erhobenen Prävalenzdaten. In der vorliegenden Übersicht werden die Ätiologie, die Pathogenese und die Klinik der HIV-assoziierten myokardialen Erkrankung dargestellt und Maßnahmen zur Überlebensverbesserung diskutiert.

Summary

Heart muscle disease is the most important cardiovascular manifestation of HIV infection and is likely to become even more prevalent as HIV infected patients live longer. This may present as myocarditis, dilated cardiomyopathy or isolated left or right ventricular dysfunction. Myocardial involvement in HIV infection is multifactorial and may arise as a result of myocardial invasion with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection, drug-related cardiac toxicity, nutritional deficiencies, and prolonged immunosuppression. Both adults and children are affected with severity ranging from incidental microscopic inflammatory findings at autopsy to clinically significant cardiac disease with chronic cardiac dysfunction. It is associated with a poor prognosis, and results in symptomatic heart failure in up to 5% of HIV patients. Clinical pathological studies from the pre-HAART era show a 30% prevalence of cardiomyopathy in patients with AIDS. The introduction of highly active antiretroviral therapy (HAART) regimens has substantially modified the course of HIV disease by lengthening survival and improving quality of life of HIV-infected patients. There is also good evidence that HAART significantly reduces the incidence of cardiovascular manifestations of HIV infection. By preventing opportunistic infections and reducing the incidence of myocarditis, HAART regimens have reduced the prevalence of HIV-associated cardiomyopathy by almost 7-fold from the pre-HAART era. HAART is however only available to a minority of HIV infected individuals in most areas of the world and studies from the pre-HAART period still apply. In this review, the aetiopathogenesis and presentation of HIV related myocardial disease were reviewed and measures taken to improve survival discussed.

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  1. Department of Medicine, Bayero University Kano, Kano, Nigeria

    Mahmoud Umar Sani

  2. Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria

    Mahmoud Umar Sani

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Correspondence to Mahmoud Umar Sani.

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Sani, M. Myocardial disease in human immunodeficiency virus (HIV) infection: a review. Wien Klin Wochenschr 120, 77–87 (2008). https://doi.org/10.1007/s00508-008-0935-3

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