Invited for debate: is virus persistence a determinant for disease progression?

Evidence-based medicine is not based on assumptions or extrapolations from experimental data in animal models but on solid evidence obtained from randomized clinical trials. There is today experimental and clinical proof of the capability of viruses to invade, persist, and replicate in the myocardium, where they can induce chronic damage. However, the pathogenetic role of viruses detected on endomyocardial biopsies is not clear, and clinical observational data published in the literature on the prognostic implications of this finding are non-uniform and need further elucidation in randomized trials, such as the currently ongoing Betaferon in Chronic Viral Cardiomyopathy (BICC) study. This is the first large randomized trial that evaluates the importance of antiviral therapy in patients with inflammatory cardiomyopathy with presence of viral genome in the myocardium. The results of the BICC trial might supply the needed scientific evidence for the clinical use of a targeted antiviral therapy for prevention of the progression of myocardial dysfunction and reversal of myocardial damage.