In situ detection of human cytomegalovirus immediate-early gene transcripts within cardiac myocytes of patients with HIV-associated cardiomyopathy

Wu, T. C.; Pizzorno, Marie C.; Hayward, Gail; Willoughby, Sharon; Neumann, David; Rose, Noel R.; Ansari, Adeel; Beschorner, William E.; Baughman, Kenneth L.; Herskowitz, Ahvie

doi:10.1097/00002030-199208000-00002

Cited by 44 publications

(17 citation statements)

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“…23,27 Cardiomyopathy in HIV infection may be due to a coinfection from a second virus or pathogen and may not always be a direct effect of the HIV virus. 28,29 On the basis of our findings, we recommend that all HIV-infected children have a 2-D echocardiogram at the time of diagnosis to determine intracardiac anatomy and baseline cardiac function. Children who have symptoms of heart failure or unexplained or prolonged respiratory disease should undergo cardiac evaluation and ultrasonography.…”

Section: Discussionmentioning

confidence: 91%

Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2 C2 HIV study

Starc

Lipshultz

Easley

et al. 2002

The Journal of Pediatrics

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Objective-To describe the 5-year cumulative incidence of cardiac dysfunction in human immunodeficiency virus (HIV)-infected children.Study design-We used a prospective cohort design, enrolling children at 10 hospitals. Group I included 205 vertically HIV-infected children enrolled at a median age of 1.9 years. Group II consisted of 600 HIV-exposed children enrolled prenatally or as neonates, of whom 93 were ultimately HIV-infected. The main outcome measures were echocardiographic indexes of left ventricular dysfunction.Results-In group I, the 5-year cumulative incidence of left ventricular fractional shortening ≤25% was 28.0%. The 5-year incidence of left ventricular end-diastolic dilatation was 21.7%, and heart failure and/or the use of cardiac medications 28.8%. The mortality rate 1 year after the diagnosis of heart failure was 52.5% [95% CI,. Within group II, the 5-year cumulative incidence of decreased fractional shortening was 10.7% in the HIV-infected compared with 3.1% in the HIV-uninfected children (P = .01). Left ventricular dilation, heart failure, and/or the use of cardiac medications were more common in infected compared with uninfected children. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusions-During 5 years of follow-up, cardiac dysfunction occurred in 18% to 39% of HIV-infected children and was associated with an increased risk of death. We recommend that HIV-infected children undergo routine echocardiographic surveillance for cardiac abnormalities.Human immunodeficiency virus (HIV) infection continues to be an important cause of morbidity and mortality in children. We designed the Pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus infection (P 2 C 2 ) HIV study to determine the incidence of heart and lung abnormalities in HIV-infected children. This study began in 1990 and data collection continued through January 1997. Our group previously reported that over the first 2 years of observation, 10% of HIV-infected children either had congestive heart failure (CHF) or required treatment with cardiac medications or both. 1 In addition, 20% of HIV-infected children had cardiac dilation or dysfunction. 1 We also reported that over the entire 6-year observation period of our study, cardiac abnormalities were the underlying cause of HIV-related death in 11 (11.8%) of 93 children and were a contributing cause in an additional 22%. 2 Furthermore, baseline cardiac dysfunction was a risk factor for death independent of CD4 count, wasting, and other predictors of death. 3Our previous report detailing the incidence of cardiac complications in HIV-infected children was limited to the first 2 years of observation in the P 2 C 2 HIV study. 1 The majority of other published studies of cardiac dysfunction in HIV-infected children have been crosssectional or short-term descriptions. [4][5][6][7][8] Because HIV infection often becomes a chronic condition, information regarding the long-term outcomes of HIV-infected c...

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Section: Discussionmentioning

confidence: 91%

Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2 C2 HIV study

Starc

Lipshultz

Easley

et al. 2002

The Journal of Pediatrics

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“…Diastolic dysfunction has also been reported in other studies. 16,17 DCM is a well-documented cardiac abnormality in HIV/AIDS and was found in 15.65% of cases, with none in the control group. 18,[22][23][24] All patients with DCM had more advanced immunosuppression with a mean CD4 count of 69/μl.…”

Section: Discussionmentioning

confidence: 99%

Cardiac manifestations in HIV patients and their correlation with CD4 count

et al. 2017

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Background: The introduction of highly active antiretroviral therapy (HAART) has significantly improved the clinical evolution of human immunodeficiency virus (HIV)/AIDS disease, with an increased survival of infected patients. With advances in the management of patients living with HIV and AIDS, not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Objectives were to determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection, and to correlate the cardiac manifestations with CD4 count.Methods: 115 HIV-positive cases and 30 healthy control subjects were evaluated by detailed history and general physical examination. CD4 was done for all patients using flowcytometry using a BD FACS Count system. All patients were evaluated using M Mode and two-dimensional transthoracic echocardiography and colour flow doppler examination.Results: Male to female ratio was1.6:1in cases. The most common symptoms were cough (54.78%), palpitations (10%), shortness of breath (52%), chest pain on exertion (18.0%) and ankle swelling (21.0%). Echocardiographic abnormalities were found in 63% of the cases compared with 6% in the controls. 18 (15.65%) patients had dilated cardiomyopathy, 17 (15%) pericardial effusion, 16 (14%) pulmonary artery hypertension, 17 (15%) mitral valve prolapses and 25 (22%) had reduced ejection fraction compared with none of controls. 54 (47%) cases had diastolic dysfunction compared with 3 (10%) controls and 40 (35%) cases had reduced fractional shortening (≤27%) compared 4 (13%) controls. Significant statistical positive correlation was not observed between low CD4 count and echocardiographic abnormalities. Pericardial effusion was seen more in patients with CD4 count below 200.Conclusions: Cardiovascular abnormalities in HIV infected patients are common and can occur without any clinical manifestation. There was no significant association between CD4 count and any cardiac manifestation.

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“…Cytomegalovirus (CMV) is a common opportunistic pathogen in AIDS, but it is associated less frequently with myocarditis [Michaels et al, 1997]. When inclusion bodies are the criterion for the detection and diagnosis of solid organ involvement by CMV, the rate of infection is underestimated compared to in situ DNA hybridization techniques [Wu et al, 1992, Myerson et al, 1984. Other viruses identified by culture or polymerase chain reaction (PCR) within the myocardium of HIV-infected or AIDS patients, either at antemortem endomyocardial biopsy or from autopsy material, have included Epstein-Barr and coxsackie B virus in adults [Barbaro et al, 1988a] and adenovirus in children [Bowles et al, 1999].…”

Section: Etiologymentioning

confidence: 99%

“…In one study, in 58 of 63 patients with AIDS, LV dysfunction, and biopsy-proven nonspecific lymphocytic myocarditis, a positive hybridization signal was observed but staining was weak and affected myocytes were generally not surrounded by inflammatory cells [Barbaro et al, 1998a]. In adults with AIDS-associated myocarditis, non-HIV viruses or viral genomic material identified in myocardial tissue has included CMV, Coxsackie virus group B, and EBV [Barbaro et al, 1998b, Wu et al, 1992. In an autopsy study of 32 children who died with advanced HIV disease, including 23 with histologic evidence of myocarditis, viral sequences detected by polymerase chain reaction included adenovirus in 6, CMV in 3, and both adenovirus and CMV in 2.…”

Section: Pathogenesismentioning

confidence: 99%

“…A high proportion of HIV-seropositive patients with LV dysfunction have evidence of latent infection of myocytes with CMV immediate-early genes [Wu et al, 1992]. Although observation of the intranuclear inclusions of active, lytic CMV infection is unusual, it has been suggested that latent viral infection may promote enhanced major histocompatibility complex expression, thereby provoking immune-mediated injury typical of animal models of myocarditis [Wu et al, 1992]. Immune-mediated mechanisms other than direct myocardial viral infection may account for the cellular infiltrates and cardiomyopathy observed in AIDS patients.…”

Section: Pathogenesismentioning

confidence: 99%

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