This is controversial. One study showed a correlation between the CD4+ counts of 100/mm3 and the presence of left ventricular (LV) dysfunction. Levy et al. showed that patients with CD4+ counts 100/mm3 and AIDS had the most cases (55%) of LV dysfunction, whereas those with a CD4+ count 100/mm3 and active AIDS or pre-AIDS had approximately the same percentage of cases of LV dysfunction (17% and 16%, respectively). However, in a young population, even these numbers are unexpectedly high. These findings suggest that HIV itself, directly or indirectly, influences the cardiac pathology.
What are the suggested therapies for dilated cardiomyopathy and heart failure in HIV-positive patients, and what is their prognosis?
Unfortunately, congestive heart failure in HIV-positive patients has been reported to have a rapidly progressive downward course. Despite the poor outcome, however, the heart failure initially responds to conventional therapy with ACE inhibitors and diuretics. Zidovudine therapy does not appear to change the poor outcome or prevent the development of dilated cardiomyopathy.