Myocarditis and Viral Myocardial Infection as Causes of Cardiomyopathy
Myocarditis and myocardial infection with HIV are the best-studied causes of dilated cardiomyopathy in HIV disease [28]. HIV-1 virions appear to infect myocardial cells in a patchy distribution with no direct association between the presence of the virus and myocyte dysfunction [28].
The myocardial fiber necrosis is usually minimal, with accompanying mild to moderate lymphocytic infiltrates. It is unclear how HIV-1 enters myocytes, which do not have CD4 receptors, although dendritic reservoir cells may play a role by activating multifunctional cytokines that contribute to progressive and late tissue damage such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-10 (IL- 10) [23]. Coinfection with other viruses (usually coxsackievirus B3 and cytomegalovirus) may also play an important pathogenetic role [21, 23].
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