Causative factors of cardiovascular complications in AIDS

Acquired immunodeficiency syndrome (AIDS) is a health crisis; approximately 60 million people are affected worldwide (1). World Health Organization estimates that as many as 110 million people worldwide may be HIV-positive before the end of this century (2). One estimate of the prevalence of cardiac involvement in patients with HIV is from 28 to 73% (3). Cardiomyopathy and myocarditis now appear to be the most important cardiac complications of AIDS in the western world (4,5). Indeed, HIV cardiomyopathy was reported as being the fourth leading cause of dilated cardiomyopathy in the United States (2). Congestive heart failure has become the leading cause of death in pediatric patients with AIDS, half of whom die of within 6 to 12 months of diagnosis (6). Cardiac syndromes described in AIDS patients include myocarditis, myocardial necrosis, cardiomyopathy, arteriopathy, endocarditis, pericardial effusion, and cardiac neoplasm. The causative factors remain unknown. But these conditions suggest that the causative factors might be 1) HIV itself, 2) cocaine abuse, 3) multiple opportunistic infections, 4) nonspecific and specific inflammatory responses, 5) autoimmune reactions, 6) catecholamine excess, 7) drug-induced cardiotoxicity, and/or 8) nutritional deficiencies.