JRSM > Volume 95, Number 1 > Pp. 57

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Selenium deficiency and HIV-associated cardiomyopathy

Giuseppe Barbaro

University "La Sapienza", 00161 Rome, Italy

E-mail: g.barbaro{at}tin.it

Dr Yusuf (November 2001 JRSM, p. 609), commenting on my review on cardiovascular manifestations of HIV infection¹, raises the question of selenium deficiency. Nutritional deficiencies must certainly be considered as potential aetiologies in HIV-related heart disease, along with myocardial infection with HIV itself, opportunistic infections, viral infections, autoimmune response to viral infection and drug-related cardiotoxicity². Nutritional deficiencies are common in late-stage disease and may contribute in inducing ventricular dysfunction independently of antiretroviral therapy². The role of selenium in the development of HIV-associated cardiomyopathy is still controversial. The relation between selenium deficiency and cardiomyopathy has also been studied in selenium-deficient mice with contrasting results³. Selenium replacement may reverse cardiomyopathy and restore left ventricular function in nutritionally depleted patients, but the evidence is mainly based on case reports⁴; controlled prospective clinical trials are lacking. Levels of vitamin B12, carnitine, and growth and thyroid hormone may also be altered in HIV disease⁵; all have been associated with left ventricular dysfunction in relation to an impairment of the process of oxidative phosphorylation and increased production of free radicals⁵. Increased lipoperoxidation and reduced glutathione levels may be observed in plasma, in peripheral mononuclear cells and in T lymphocytes of HIV-infected patients^6,7, especially those who are coinfected with hepatitis C virus⁸, independently of nutritional disorders. I agree with Dr Yusuf that nutritional disorders (including selenium deficiency) should be carefully checked in HIV-infected patients but HIV-associated cardiomyopathy should not be compared to Keshan disease because of its multifactorial pathogenesis².

REFERENCES

1. Barbaro G. Cardiovascular manifestations of HIV infection. J R Soc Med2001; 94:384 -90[Free Full Text]

2. Barbaro G, Fisher SD, Lipshultz SE. Pathogenesis of HIV-associated cardiovascular complications. Lancet Infect Dis2001; 1:115 -24[CrossRef][Medline]

3. Beck MA, Kolbeck PC, Shi Q, Rohr LH, Morris VC, Levander OA. Increased virulence of a human enterovirus (coxsackievrius B3) in selenium-deficient mice. J Infect Dis1994; 170:351 -7[Medline]

4. Chariot P, Perchet H, Monnet I. Dilated cardiomyopathy in HIV- infected patients. N Engl J Med1999; 340:732[Free Full Text]

5. Hoffman M, Lipshultz SE, Miller TL. Malnutrition and cardiac abnormalities in the HIV-infected patients. In: Miller TL, Gorbach S, editors. Nutritional Aspects of HIV Infection. London: Arnold,1999 : 33-9

6. Staal FJT, Ela SW, Roederer M, Anderson MT, Herzenberg LA. Glutathione deficiency and human immunodeficiency virus infection. Lancet1992; 339:909 -12[CrossRef][Medline]

7. Staal FJT, Roederer M, Israelski DM, et al. Intracellular glutathione levels in T cell subsets decrease in HIV-infected individuals. AIDS Res Hum Retroviruses1992; 8:305 -11[Medline]

8. Barbaro G, Di Lorenzo G, Soldini M, et al. Vagal system impairment in human immunodeficiency virus-positive patients with chronic hepatitis C: does glutathione deficiency have a pathogenetic role? Scand J Gastroenterol1997; 32:1261 -6[Medline]

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				T. O Cheng Selenium deficiency and cardiomyopathy J R Soc Med, January 4, 2002; 95(4): 219 - 220. [Full Text] [PDF]

This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barbaro, G. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?