Prevalent myocarditis at necropsy in the acquired immunodeficiency syndrome

Abstract

The prevalence of myocarditis was retrospectively evaluated in 71 consecutive necropsy patients who died from acquired immunodeficiency syndrome (AIDS) between 1982 and 1986. Myocarditis was found in 37 cases (52%). Biventricular dilation at necropsy was present in seven cases (10%) and was accompanied by myocarditis in each case; fatal congestive heart failure occurred in four of these seven cases. Although viral, protozoan, bacterial, fungal and mycobacterial opportunistic pathogens were present in myocardial sections of 7 of 37 myocarditis cases, the etiology of myocarditis in the majority of these patients with AIDS remained idiopathic. Thus, myocarditis is a frequent finding at necropsy in patients with AIDS and may contribute to the development of biventricular dilation.

The Human Immunodeficiency Virus-1 Tat Protein Activates Human Umbilical Vein Endothelial Cell E-selectin Expression via an NF-κB-dependent Mechanism

“…Cardiovascular complications, such as myocarditis with infiltrating neutrophils and mononuclear cells are often observed, even in the absence of infectious pathogens (1,2). Even though HIV may enter endothelial cells via transcytosis (3), productive infection is very hard to achieve unless the cells are proliferating in the presence of cytokines (4).…”

Myocarditis in HIV Positive Patients

“…Myocarditis identified at autopsy or on endomyocardial biopsy in HIV-infected patients is most often nonspecific and manifested as focal, inflammatory lymphocytic infiltrates without myocyte necrosis. Other reported histopathologic findings include lymphocytic infiltration with myocyte necrosis fulfilling the Dallas criteria or myocyte damage without associated cellular inflammatory infiltrate [Anderson et al, 1988, Barbaro et al, 1998]. The autopsy finding of focal myocarditis in many patients who die of AIDS-related complications, but have no known premortem heart disease, suggests that focal lymphocytic infiltration may have no clinical significance.…”

“…The autopsy finding of focal myocarditis in many patients who die of AIDS-related complications, but have no known premortem heart disease, suggests that focal lymphocytic infiltration may have no clinical significance. By comparison, diffuse lymphocytic myocarditis meeting the Dallas criteria appears rare [Anderson et al, 1988]. The prevalence of nonspecific myocarditis is related to the stage of HIV infection and the presence of structural heart disease.…”

“…Toxoplasma gondii (T gondii) is the most frequently documented infectious cause of myocarditis associated with AIDS, and the heart is the second most common site of infection after the brain. Autopsy series have described T gondii myocarditis (myocardial toxoplasmosis) in 1% to 16% of patients dying of AIDS [Baroldi et al, 1988, Anderson et al, 1988, Matturi et al, 1990. Evidence of myocardial toxoplasmosis includes trophozoites or pseudocysts in myocardial fibers.…”

“…However, whether these mechanisms operate in the myocarditis and dilated cardiomyopathy of AIDS is unknown. Three histological patterns of myocarditis have been described in patients with AIDS: -lymphocytic infiltration with myocyte necrosis [Anderson et al, 1988], which meets the Dallas criteria; -lymphocytic infiltration without inflammation ; -myocyte damage without evidence of inflammatory infiltrate [Lafontet al, 1987].…”