Myocardial and microvascular inflammation/infection in patients with HIV-associated pulmonary artery hypertension

AIDS. 2014 Nov 13;28(17):2541-9. doi: 10.1097/QAD.0000000000000426.


Background: Right ventricle compromise affects survival of patients with HIV-associated pulmonary artery hypertension (PAH).

Design: Myocardial histology with viral assessment may clarify the mechanism of right ventricular deterioration and provide clues on PAH origin.

Methods: Fifteen patients with HIV infection, PAH and right ventricular dysfunction underwent cardiac magnetic resonance, catheterization, coronary with ventricular angiography and biventricular endomyocardial biopsy. Endothelial expression of HLA-DR, ICAM-1, E-selectin and VCAM-1 was semi-quantitatively evaluated. PCR for HIV, hepatitis C virus, human herpes virus-6, human herpes virus-8, Epstein-Barr virus, adenovirus, cytomegalovirus, enterovirus, influenza A/B and parvovirus B19 was performed. In PCR-positive hearts, viral protein adenovirus-1 and TORDJI-22 were assessed by immunohistology.

Results: New York Heart Association class was 2.4 ± 0.5, mean pulmonary artery pressure 49.93 ± 10.15 mmHg and wedge pressure 9.5 ± 2.19 mmHg. Coronaries were normal with slow flow. Left ventricular and/or right ventricular micro-aneurysms were seen in eight patients. Cardiac magnetic resonance documented increased right ventricular end-diastolic volume with reduced ejection fraction, normal left ventricular end-diastolic volume and left ventricular ejection fraction. Subepicardial/mesocardial oedema and delayed enhancement in the inter-ventricular junction and/or left ventricular inferolateral wall was detected in eight patients. Histology showed active lymphocytic myocarditis in 12 patients, with microvasculitis in three. Endothelial adhesion molecules were over-expressed in all patients. PCR was positive in four patients for hepatitis C virus and in two for adenovirus, and viruses localized both in cardiomyocytes and endothelial cells.

Conclusions: Inflammation/infection of myocardium and intramural vessels is detectable in patients with HIV-associated PAH. It may adversely affect right ventricular function and have a role in the compromised pulmonary circulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Coinfection / diagnosis*
  • Coinfection / pathology
  • Coinfection / virology
  • Female
  • HIV Infections / complications*
  • Humans
  • Hypertension, Pulmonary / pathology*
  • Male
  • Microvessels / pathology
  • Middle Aged
  • Myocarditis / pathology*
  • Myocardium / pathology
  • Vasculitis / pathology*
  • Viruses / classification
  • Viruses / isolation & purification*