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Autoimmunity as a Contributor to Cardiomyopathy

Cardiac-specific autoantibodies (anti-alpha- myosin autoantibodies) are more common in HIV-infected patients with dilated car­diomyopathy than in HIV-infected patients with healthy hearts.

Currie et al. reported that HIV-infected patients were more likely to have specific cardiac autoantibodies than were HIV-negative control subjects [29]. Those with echocardiographic evidence of left ventricular dysfunction were particular­ly likely to have cardiac autoantibodies, supporting the theory that cardiac autoim­munity plays a role in the pathogenesis of HIV-related heart disease and suggesting that cardiac autoantibodies could be used as markers of left ventricular dysfunction in HIV-positive patients with previously nor­mal echocardiographic findings [29].

In addition, monthly intravenous admin­istration of immunoglobulin in HIV-infected pediatric patients minimizes left ventricu­lar dysfunction, increases left ventricular wall thickness, and reduces peak left ven­tricular wall stress, suggesting that both impaired myocardial growth and left ven­tricular dysfunction may be immunological­ly mediated [30]. These effects may be the result of immunoglobulins inhibiting car­diac autoantibodies by competing for Fc receptors, or they could be the result of immunoglobulins dampening the secretion or effects of cytokines and cellular growth factors [30]. These findings suggest that immunomodulatory therapy might be help­ful in adults and children with declining left ventricular function, although further study of this possible therapy is needed.

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Source: Barbaro Giuseppe, Boccara Franc (eds.). Cardiovascular Disease in AIDS. 2nd edition. — Springer,2009. — 169 p.. 2009
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