Cardiac impairment in HIV positive patients is a very frequent complication which is observed in 25 to 75 % of patients. In patients with AIDS, myocarditis was post-mortem identified in 40 to 52 % of cases [34]. Some resources warn about the increase in cardiac manifestation in HIV positive patients what is according to the references connected with a longer survival time of these patients because of an effective therapy [33, 34].

Aetiology of myocarditis in HIV positive patients is unclear. Besides a direct viral infection with HIV, myocarditis could be caused by different infections in association with immunosuppression of the immune system (Toxoplasma gondii, Mycobacterium tuberculosis, EBV, Coxsackie B, CMV etc.), [63, 64], autoimmune mechanisms (auto-antibodies production), [65], drug toxicity, nutritive conditions (for example lack of selenium), [66] and mitochondrial dysfunction as a result of viral activity [69]. Even higher levels of TNF alpha, IL-6, and other cytokines were observed in patients.

Manifestation and clinical picture of HIV positive patients with myocarditis are similar to other myocarditis types and also include a wide spectrum from asymptomatic individuals to cases presenting as a sudden death [70].

Treatment of myocarditis in HIV positive individuals is still not standardized including heart failure management, however, still standard heart failure therapy (ACE inhibitors, beta blocker, alternatively other therapeutic options) is recommended, [67, 68]. Some resources state that opportunist infection should be treated aggressively [34]. The role of antiretroviral therapy in the therapy of myocarditis in HIV positive individuals is uncertain. Rather its protective effect is described [66, 67]. Immunological therapy is also not standardized, even though in HIV positive children, therapy with IVIG was connected with the heart function improvement [71]. Controversial is treatment with mechanical supports and with heart transplant [67]. When nutritional deficit occurs, use of selenium, multivitamins and other substances is recommended [34].

Prognosis of patients is generally unclear and often unfavorable. There is a worse prognosis primarily in patients with the development of heart failure [34]. In a study including even 45 patients with HIV induced cardiomyopathy, this group belonged to groups with the worst prognosis and 5-year survival rate of 25 % [72]. Other study described the median of the survival in patients with AIDS and cardiomyopathy 101 days in comparison with 472 days in patients without cardiac manifestation [73]. In a study of HIV positive children, the better prognosis was described [74]. 5-year mortality based on the left ventricular FS score varied between 15 and 55 %.

Author of the opening picture: BruceBlaus

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References:

33) CAMBREA S. C. Chapter 8: Myocarditis in HIV Positive Patients. In: WILSON J. Clinical Handbook of Myocarditis. New Jersey: Foster Academics, 2015. pp. 165-182. ISBN: 978-1-63242-083-1.

34) FISHER S. D., LIPSHULTZ S. E. Cardiovascular Abnormalities in HIV-Infected Individuals.: D.P., ZIPES, MANN D.L., LIBBY P., BONOW R.O. a BRAUNWALD E. (eds.). Braunwald´s Heart Disease: A Textbook of Cardiovascular medicine. Tenth edition. Philadelphia: Elsevier Saunders, 2015. pp. 1624–1635. ISBN 978-1-4557-5133-4.

63) SHIRANI a et al. CARDIOVASCULAR IMAGING IN CLINICAL AND EXPERIMENTAL ACUTE INFECTIOUS MYOCARDITIS. Frontiers in Bioscience. 2003, 8(-), e323 – e336.

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66) H., LUMSDEN a et al. The Causes of HIV-Associated Cardiomyopathy: A Tale of Two Worlds. BioMed Research International [online]. 2016, 2016(-), 9 stránek [cit. 2017-02-05].

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68) OLSON L. J. Chapter 22: Myocarditis Associated With Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. In: L.T., JR., COOPER, ed. Myocarditis: From Bench to Bedside. USA: Humana Press, 2003. pp. 545–558. ISBN 1-58829-112-X.

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