Pathogenesis of AIDS-Related Dilated Cardiomyopathy

The development and application of new more effective antiretroviral therapies and the expanding number of newly diagnosed cases of AIDS have contributed to an overall increase in the number and variety of HIV-related chronic diseases including AIDS related heart disease. AIDS patients have a higher incidence of infectious myocarditis due to their underlying immune deficiencies. However, there is an increasing number of cardiomyopathies of presumable non-infectious origin being reported among HIV-infected individuals. Many heart conditions appearing in AIDS patients resemble chronic dilated cardiomyopathies (DCMs) which are usually seen in older uninfected individuals and suggests that a unique set of risk factors exists for the accelerated development of AIDS-related DCM. Both AIDSrelated and non-AIDS-related DCM develop after the triggering of tissue remodeling and reinforcement programs in response to cardiac insult. In AIDS patients with co-existing clinical conditions, e.g. opportunistic infections, nutritional deficiencies, cardiotoxic effects of HAART and illicit drug use provide for a greater variety of external triggers that potentially contribute to the increased heterogeneity of clinical manifestations seen in HIV-related DCM. This review will focus on unique factors that play a role in the etiology of AIDS-related DCM that have evolved along four separate and overlapping pathogenic pathways: interactions between HIV-infected leukocytes and the cardiac microvascular endothelium, viral interactions with cardiac tissues, AIDS-related nutritional deficiencies, and the cardiotoxic effects of therapeutic and illicit drugs.