CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
AFRICA
e5
our study. In their study DCM was also strongly associated with
advanced immunosuppression.
No definitive aetiologies were determined for heart muscle
disease in our study. The aetiopathogenesis of cardiomyopathy
remains unclear, often multifactorial.
3,29,34,42
Myocarditis and
direct HIV invasion of myocardial tissue are the most studied
causes of dilated cardiomyopathy in HIV infection.
2,5,6,42
Co-infection with other cardiotropic viruses such as Coxsackie
virus, cytomegalovirus and Epstein-Barr virus have also been
reported.
3,5,6,34,43
Other causes include the cardiotoxic effect of antiretroviral
drugs such as zidovudine,
26,34,44
autoimmunity,
3,25,45,46
and
nutritional factors such as deficiency of selenium and other trace
elements.
3,5,7,17,47
Selenium deficiency as a cause of HIV-related
heart muscle disease may be of considerable interest in Africa
9
and in our study, considering that most of these patients present
with multiple nutritional deficiencies, prolonged diarrhoea and
wasting, which may involve selenium deficiency.
9
Selenium
supplementation has been shown to improve cardiac dysfunction
in these patients.
2,4,5,7,17
Isolated right heart dilatation with dysfunction was found in
one of the patients in our study, who had significant pulmonary
disease of over six months’ duration (Fig. 3). The very low
CD
4
count of 64/
µ
l in this patient suggested some relationship
with severe disease progression, as reported in other studies as
well.
18,20
One of the patients in our study, with a CD
4
of 171/
µ
l,
had aortic root dilatation, which was associated with severe
aortic regurgitation (Fig. 4). Although not common, aortic
root dilatation and even aneurysm has been reported in other
studies.
20,48
This may be the beginning of large-vessel vasculitis
of possible infective or immune-complex origin, involving the
aorta and its major branches, which has been reported by other
workers.
49,50
Our study did not evaluate other possible co-morbidities,
such as HIV-associated nephropathy and anaemia, which may be
present in the patients aside from cardiovascular abnormalities.
We also could not use newer methods, such as tissue Doppler,
to assess diastolic function. This was unfortunate because tissue
Doppler is more reliable than the method used in our study, it
helps to clarify the issue of pseudonormalisation, and it is less
load-dependent. Furthermore, we could not assess the prognostic
implications of cardiovascular involvement in our subjects.
Conclusion
In view of the high frequency of cardiac abnormalities detected
by echocardiography in the HIV/AIDS patients in our study, it is
suggested that HIV-positive patients should have a careful initial
and periodic cardiac evaluation to detect early involvement of the
heart in the HIV disease.
We thank Dr Oridota for useful advice and statistical input, Matron Bastos,
Mr Hakeem and all members of staff of the HIV clinic in LUTH for their
support and encouragement throughout this work.
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Fig. 3. Apical four-chamber view showing isolated right
ventricular and atrial dilatation. Note the significantly
enlarged right ventricle and right atrium, compared with
the small left ventricle and left atrium.
Fig. 4. Apical five-chamber view of one of the patients with
a dilated aortic root, showing moderate to severe aortic
regurgitation. Note the red flame from the middle (aortic
ring) extending towards the apex of the left ventricle.
