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CLINICAL STUDIES

The detection of viral genomes by polymerase chain reaction in the myocardium of pediatric patients with advanced HIV disease

Neil E. Bowles, PhD^* , Debra L. Kearney, MD , Jiyuan Ni, MD^* , Antonio R. Perez-Atayde, MD^||, Mark W. Kline, MD , J. Timothy Bricker, MD, FACC^* , Nancy A. Ayres, MD, FACC^* , Steven E. Lipshultz, MD^¶,2, William T. Shearer, MD, PhD and Jeffrey A. Towbin, MD, FACC^{* #,1 2}

^* Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
Section of Allergy and Immunology, Baylor College of Medicine, Houston, Texas, USA
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
Departments of Pediatrics and Pathology, Baylor College of Medicine, Houston, Texas, USA
^|| Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
^¶ Division of Pediatric Cardiology, University of Rochester Medical Center, Rochester, New York, USA
^# Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA

Manuscript received June 17, 1998; revised manuscript received April 9, 1999, accepted May 16, 1999.

Reprint requests and correspondence: Dr. Jeffrey A. Towbin, Department of Pediatrics (Cardiology), Room 333E, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030
jtowbin{at}bcm.tmc.edu

OBJECTIVES

The aim of this study was to investigate the frequency of viral nucleic acid detection in the myocardium of human immunodeficiency virus (HIV)-infected children to determine whether an association exists with the development of heart disease.

BACKGROUND

As improved medical interventions increase the life expectancy of HIV-infected patients, increased incidences of myocarditis and dilated cardiomyopathy (DCM) are becoming more apparent, even in patients without clinical symptoms.

METHODS

Myocardial samples were obtained from the postmortem hearts of 32 HIV-infected children and from 32 age-matched controls consisting of patients with structural congenital heart disease and no myocardial inflammation and no cardiac or systemic viral infection. The hearts were examined histologically and analyzed for the presence of viral sequences by polymerase chain reaction (PCR) or reverse transcription-PCR.

RESULTS

Myocarditis was detected histologically in 11 of the 32 HIV-infected patients, and borderline myocarditis was diagnosed in another 13 cases. Infiltrates were confined to the epicardium in two additional hearts. Virus sequences were detected by PCR in 11 of these 26 cases (42.3%); adenovirus in 6, CMV in 3 and both adenovirus and CMV in 2. Two cases without infiltrates were also positive for adenovirus: one had congestive heart failure (CHF) and the other adenoviral pneumonia. No other viruses were detected by PCR, including HIV proviral DNA. All control samples were negative for all viruses tested.

CONCLUSIONS

These data suggest that the presence of viral nucleic acid in the myocardium is common in HIV-infected children, and may relate to the development of myocarditis, DCM or CHF and may contribute to the rapid progression of HIV disease.

Abbreviations and Acronyms   AIDS = acquired immunodeficiency syndrome   CDC = Center for Disease Control   CHF = congestive heart failure   CMV = cytomegalovirus   DCM = dilated cardiomyopathy   EBV = Epstein-Barr virus   HIV = human immunodeficiency virus   HSV = herpes simplex virus   PCR = polymerase chain reaction   RSV = respiratory syncytial virus   RT = reverse transcription

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