MedUni Vienna: HIV infection: Heart Muscle Cells Die even During the Acute Phase

During the first few days of an HIV infection most patients experience flu-like symptoms, which soon disappear without any treatment

During the first few days of an HIV infection most patients experience flu-like symptoms, which soon disappear without any treatment. A team of MedUni Vienna researchers led by Christopher Schuster, Georg Goliasch and the head of the HIV outpatient clinic at MedUni Vienna/Vienna General Hospital, Armin Rieger, have now shown that it is during this early acute phase that damage occurs to the heart muscle cells –thereby potentially increasing the risk of subsequently developing heart disease. The study was published in the prestigious "Journal of Infectious Diseases".

Approximately two million people a year worldwide become infected with HI Virus (Human Immunodeficiency Virus). According to Aids Hilfe Wien, 447 new HIV diagnoses were recorded in Austria in 2016. Treatment of the condition has changed a great deal over the past 20 years and, thanks to anti-retroviral therapy, it is now possible to prevent the onset of AIDS (Acquired Immune Deficiency Syndrome). So long as HIV-positive people take their medication – which is now very well tolerated – consistently, their life expectancy is similar to that of someone not infected with HIV.

During the acute HIV infection, that is to say approximately one to two weeks after transmission, there are a huge number of HI viruses in the patient's blood but no specific antibodies against HIV, as these only develop after a few weeks. The immune system is very active during this phase and this is also manifested by a pronounced systemic inflammatory reaction in the blood. The risk of infection during this phase is very high due to the massive viral load in the blood and in genital secretions. Flu-like symptoms can occur, such as fever, enlarged lymph nodes, skin rashes and muscle pain. As a rule, these symptoms abate spontaneously after approximately two weeks, so that very few people receive a specific diagnosis at this stage. Say dermatologists Christopher Schuster and Armin Rieger: "It is important to know that it is not so much the objectifiable symptoms but rather the patient's history of any high-risk behaviour that helps to arrive at the correct diagnosis." 

The research team, led by dermatologist Christopher Schuster from the Department of Dermatology, cardiologist Georg Goliasch from the Department of Medicine II and dermatologist and head of the HIV Clinic, Armin Rieger, has now shown in a study including 49 patients that, in approximately one in four patients, heart muscle cells already die in the acute phase due to the massive increase in HIV viral load and the simultaneous immune activation that occurs. Specifically, special biomarkers that indicate functional impairment or structural damage to the heart were taken at the time of the acute HIV infection and again after drug-induced suppression of virus replication and compared, taking account of various secondary factors.

The study, published in the "Journal of Infectious Diseases”, suggests that those patients with so-called silent involvement of the myocardial cells in the acute phase, should be closely monitored. This would allow early detection of any potential development of future heart diseases, so that they could be treated at an early stage.

As regards treatment for HIV, it is worth pointing out that, since the “START" study in 2015, HIV patients are treated lege artis immediately after diagnosis, regardless of their immune status. Before that, the standard approach was only to start drug treatment after a certain threshold was reached. It remains to be seen whether the risk of cardiac disease in HIV-positive patients can be reduced over the coming years by starting treatment early, say the MedUni Vienna experts.

Service: The Journal of Infectious Diseases

Acute HIV Infection Results in Subclinical Inflammatory Cardiomyopathy. Christopher Schuster Florian J Mayer Corinna Wohlfahrt Rodrig Marculescu Michael Skoll Robert Strassl Noemi Pavo Theresia Popow-Kraupp Martin Hülsmann Martin Bauer Maximilian C Aichelburg Armin Rieger Georg Goliasch. Doi/10.1093/infdis/jiy183/4955987

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