Ischemic Heart Disease

The association between viral infection (cytomegalovirus or HIV-1 itself) and coro­nary artery lesions is not clear. HIV-1 sequences have been detected by in situ hybridization in the coronary vessels of an HIV-infected patient who died from acute myocardial infarction (Fig.

Fig. 2 In situ hybridization from an endomyocardial biop­sy sample in an HIV-infected subject with echocardiograph­ic diagnosis of dilated car­diomyopathy (left ventricular ejection fraction: 28%) and histologic diagnosis of active myocarditis. It is possible to observe two myocytes show­ing a positive signal for nucle­ic sequences of HIV-1 (ar­rows). H&E, x20

Fig. 3 In situ hybridization of an HIV-1 RNA probe in a transverse section of a branch of the anterior descending coronary artery. Intense staining indicating the presence of HIV-1 sequences within the intima and the media (arrows). There is a dense lymphocyte infiltrate within the media and necrosis of the inti­ma, which is covered with swollen endothelial cells. (From [7], Copy­right© 2001 Massachusetts Medical Society. All right reserved). H&E, x280

bolic syndrome during therapy [9]. Howev­er, studies on the risk of coronary heart dis­ease in this subset of patients remain con­troversial [10-14].

Pathologic examination of coronary arteries generally reveals eccentric fibroatheromatous plaques with variable degrees of chronic inflammatory infiltrates. Lesions with morphologic features similar to accelerated arteriosclerosis have been described at autopsy of young HIV-infected patients [2, 3]. The pathology of coronary and peripheral vessels in HIV infection is described in detail by A. Tabib and R. Loire in a separate chapter in this volume.