Human immunodeficiency virus infection after heart transplantation: Development of cardiomyopathy after long-term survival

A case of human immunodeficiency virus (HIV) infection following heart transplantation is reported. The patient acquired HIV infection at surgery after receiving blood transfusions from an HIV seronegative donor who subsequently seroconverted. The patient was followed for 84 months following transplantation. He was immunosuppressed with cyclosporine and prednisone and his CD4+ lymphocyte count remained less than 200 cells/mm3. Before death, a progressive worsening of cardiac function was observed without any evidence of acute or chronic rejection. Death due to end-stage cardiomyopathy in the presence of opportunistic infections occurred suddenly. Cardiomyopathy might have been related to either antiretroviral treatment or HIV infection or both. The patient had a long-term survival, in spite of chronic immunosuppression, early development of low CD4+ count and early onset of an acquired immunodeficiency syndrome (AIDS)-defining illness. The possibility of a synergistic antiretroviral activity of cyclosporine in combination with zidovudine is discussed. Reported cases of HIV infection acquired after heart transplantation are reviewed.