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J R Soc Med. 2002 January; 95(1): 57.
PMCID: PMC1279168

Selenium deficiency and HIV-associated cardiomyopathy

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 patients6,7, 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.


1. Barbaro G. Cardiovascular manifestations of HIV infection. J R Soc Med 2001;94: 384-90 [PMC free article] [PubMed]
2. Barbaro G, Fisher SD, Lipshultz SE. Pathogenesis of HIV-associated cardiovascular complications. Lancet Infect Dis 2001;1: 115-24 [PubMed]
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 Dis 1994;170: 351-7 [PubMed]
4. Chariot P, Perchet H, Monnet I. Dilated cardiomyopathy in HIV- infected patients. N Engl J Med 1999;340: 732 [PubMed]
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. Lancet 1992;339: 909-12 [PubMed]
7. Staal FJT, Roederer M, Israelski DM, et al. Intracellular glutathione levels in T cell subsets decrease in HIV-infected individuals. AIDS Res Hum Retroviruses 1992;8: 305-11 [PubMed]
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 Gastroenterol 1997;32: 1261-6 [PubMed]

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