HIV-associated cardiomyopathy
HIV-associated cardiomyopathy
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DOI：
10.1007/s00059-005-2728-z
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发表时间：
2005-09-01
期刊：
影响因子：
1.7
通讯作者：
Barbaro, G
中科院分区：
文献类型：
--
作者：
Barbaro, G
人类免疫缺陷病毒(HIV)病被认为是扩张型心肌病的重要原因。在HIV疾病中，心肌炎和感染HIV-1的心肌感染是研究最多的心肌病原因。HIV-1病毒粒子似乎以斑块状分布感染心肌细胞，病毒的存在与心肌细胞功能障碍之间没有直接联系。心肌树突状细胞似乎通过激活多功能细胞因子(即肿瘤坏死因子-α)和诱导型一氧化氮合酶而发挥重要的致病作用，从而导致进行性和晚期心肌组织损伤。与其他病毒(通常是柯萨奇病毒B3和巨细胞病毒)的混合感染也可能起到重要的致病作用。高效抗逆转录病毒疗法(HAART)的引入显著降低了生活在发达国家的艾滋病毒感染患者的心肌炎发生率。相比之下，在发展中国家，HAART的可获得性很少，营养因素的致病作用更大，艾滋病毒相关性心肌炎和心肌病的发病率正在增加，充血性心力衰竭的死亡率很高。艾滋病毒感染者可能很难临床诊断心肌炎或充血性心力衰竭，因为伴随的支气管肺疾病和/或虚弱综合征掩盖了症状，特别是在艾滋病毒疾病的较晚期。免疫调节疗法(静脉注射免疫球蛋白)可能对患有HIV相关性心肌炎和左心功能下降的成人和儿童有帮助。关于HAART在治疗HIV相关性心肌炎和心肌病中的作用的数据缺乏。
Human immunodeficiency virus (HIV) disease is recognized as an important cause of dilated cardiomyopathy. Myocarditis and myocardial infection with HIV-1 are the best-studied causes of cardiomyopathy in HIV disease. HIV-1 virions appear to infect myocardial cells in a patchy distribution with no direct association between the presence of the virus and myocyte dysfunction. Myocardial dendritic cells seem to play a significant pathogenetic role by activating multifunctional cytokines (i.e., tumor necrosis factor-alpha) and the inducible form of nitric oxide synthase that contribute to progressive and late myocardial tissue damage. Coinfection with other viruses (usually, coxsackievirus B3 and cytomegalovirus) may also play an important etiopathogenetic role.The introduction of highly active antiretroviral therapy (HAART) has significantly reduced the incidence of myocarditis in HIV-infected patients living in developed countries. By contrast, in developing countries, where the availability of HAART is scanty and greater is the pathogenetic role of nutritional factors,the incidence of HIV-associated myocarditis and cardiomyopathy is increasing with a high mortality rate for congestive heart failure.A clinical diagnosis of myocarditis or congestive heart failure may be difficult in an HIV-infected patient due to masking of symptoms by concomitant bronchopulmonary disease and/or wasting syndromes,especially in a more advanced stage of HIV disease. Immunomodulatory therapy (intravenous immunoglobulins) may be helpful in adults and children with HIV-associated myocarditis and declining left ventricular function. Data on the role of HAART in the treatment of HIV-associated myocarditis and cardiomyopathy are lacking.