Cardiac Dysfunction in HIV

Cardiac dysfunction is quite common in patients with advanced HIV and is multifactorial.

1) Myocarditis - fairly common, and can be due to many infectious pathogens (bacterial, fungal, protozoal, viral).  Most common culprits are Toxoplasmosis, also CMV, Coxsackie (as in normal hosts).  It is controversial whether or not HIV itself can directly cause myocarditis (as opposed to concomitant OIs and illicit drugs, etc) but many experts do believe that it does.

2) Dilated Cardiomyopathy - up to 10% of patients with AIDS have a clinically significant cardiomyopathy, and many more have subclinical LV dysfunction on echocardiogram.  In addition to being sequelae from myocarditis as above, HIV/AIDS patients commonly have comorbidities which lead to cardiomyopathy - namely, Illicit drugs (cocaine, methamphetamines, alcohol), and there are also reports of some HAART meds having cardiotoxicity (for example, Zidovudine).

3)  Pulmonary Hypertension - also fairly common, and again the debate is whether it is from infections or drug abuse (i.e. methamphetamines leading to pulmonary hypertension), or an effect of HIV itself on the smooth muscle of the pulmonary vasculature.
Don't forget that now with HIV patients living longer and longer, the negative effect of HAART therapy on lipid profiles and atherosclerosis is becoming more important, as many patients now die from cardiovascular causes rather than infections.

(Chanu Rhee MD, 1/21/11)