CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
218
AFRICA
Prevalence of myocarditis and cardiotropic virus infection
in Africans with HIV-associated cardiomyopathy, idiopathic
dilated cardiomyopathy and heart transplant recipients:
a pilot study
GASNAT SHABOODIEN, CHRISTOPHER MASKE, HELEN WAINWRIGHT, HEIDI SMUTS, MPIKO NTSEKHE,
PATRICK J COMMERFORD, MOTASIM BADRI, BONGANI M MAYOSI
Abstract
Background:
The prevalence of myocarditis and cardiotropic
viral infection in human immunodeficiency virus (HIV)-
associated cardiomyopathy is unknown in Africa.
Methods:
Between April 2002 and December 2007, we
compared the prevalence of myocarditis and cardiotropic
viral genomes in HIV-associated cardiomyopathy cases with
HIV-negative idiopathic dilated cardiomyopathy patients (i.e.
negative controls for immunodeficiency) and heart trans-
plant recipients (i.e. positive controls for immunodeficiency)
who were seen at Groote Schuur Hospital, Cape Town, South
Africa. Myocarditis was sought on endomyocardial biopsy
using the imunohistological criteria of the World Heart
Federation in 33 patients, 14 of whom had HIV-associated
cardiomyopathy, eight with idiopathic dilated cardiomyopa-
thy and 11 heart transplant recipients.
Results:
Myocarditis was present in 44% of HIV-associated
cardiomyopathy cases, 36% of heart transplant recipients,
and 25% of participants with idiopathic dilated cardiomyo-
pathy.While myocarditis was acute in 50% of HIV- and heart
transplant-associated myocarditis, it was chronic in all those
with idiopathic dilated cardiomyopathy. Cardiotropic viral
infection was present in all HIV-associated cardiomyopathy
and idiopathic dilated cardiomyopathy cases, and in 90%
of heart transplant recipients. Multiple viruses were identi-
fied in the majority of cases, with HIV-associated cardio-
myopathy, heart transplant recipients and idiopathic dilated
cardiomyopathy patients having an average of 2.5, 2.2 and 1.1
viruses per individual, respectively.
Conclusions:
Acute myocarditis was present in 21% of cases
of HIV-associated cardiomyopathy, compared to none of
those with idiopathic dilated cardiomyopathy. Infection with
multiple cardiotropic viruses may be ubiquitous in Africans,
with a greater burden of infection in acquired immunodefi-
ciency states.
Keywords:
HIV-associated cardiomyopathy, myocarditis, dilated
cardiomyopathy, cardiotropic virus
Submitted 6/4/13, accepted 13/5/13
Published online 14/6/13
Cardiovasc J Afr
2013;
24
: 218–223
DOI: 10.5830/CVJA-2013-039
Dilated cardiomyopathy is a common manifestation of
HIV-associated cardiovascular disease in Africans.
1
Little
is known, however, about the cause of cardiomyopathy in
HIV-infected people living in Africa, a continent with the largest
number of people with HIV/AIDS in the world.
2-4
A number
of hypotheses regarding the pathogenesis of HIV-associated
cardiomyopathy have been proposed including myocarditis due
to direct infection with HIV or other cardiotropic viruses, genetic
predisposition, and nutritional deficiencies.
4-6
An autopsy study of 16 patients with HIV/AIDS from the
Democratic Republic of the Congo reported histopathological
changes of acute myocarditis in all cases, which were attributed
to opportunistic infection with
Toxoplasma gondii
in three of
16 cases (18.75%),
Cryptococcus neoformans
in three of 16
cases (18.75%) and
Mycobacterium avium intracellulare
in
two of 16 cases (12.5%), and to direct HIV infection in eight
of 16 (50%) patients.
7
This report raises the possibility that
HIV-associated cardiomyopathy may be caused by potentially
treatable opportunistic infections in up to 50% of patients living
in the sub-Saharan region.
2
By contrast, in Western series,
opportunistic viral infections or idiopathic causes have been
implicated in a significant proportion of cases of HIV-associated
cardiomyopathy.
8,9
To the best of our knowledge, there have been no ante-mortem
studies on the prevalence of myocarditis and cardiotropic viral
infection in patients with HIV-associated cardiomyopathy living
inAfrica.
2-4
The aim of this study was to determine the prevalence
and type of myocarditis and cardiotropic viral infection in
The Cardiac Clinic and the Hatter Institute for Cardiovascular
Research in Africa, Department of Medicine, Groote Schuur
Hospital and University of Cape Town, Cape Town, South
Africa
GASNAT SHABOODIEN, PhD
MPIKO NTSEKHE, MD, PhD
PATRICK J COMMERFORD, MB ChB, FCP (SA)
MOTASIM BADRI, PhD
BONGANI M MAYOSI, MB ChB, DPhil,
Division of Anatomical Pathology, Department of Clinical
Laboratory Sciences, National Health Laboratory Service
and University of Cape Town, Cape Town, South Africa
CHRISTOPHER MASKE, MB ChB, DPhil
HELEN WAINWRIGHT, MB ChB, FCPath (SA) Anat
Division of Medical Virology, Department Clinical
Laboratory Sciences, National Health Laboratory Service
and University of Cape Town, Cape Town, South Africa
HEIDI SMUTS, PhD
College of Medicine, King Saud Bin Abdulaziz University for
Health Sciences, Riyadh, Kingdom of Saudi Arabia
MOTASIM BADRI, PhD
