AIDS na infância: acometimento cardíaco com e sem a terapia anti-retroviral tríplice combinada

Cunha, Maria do Carmo Soares Alves; Filho, Aristarco Gonçalves de Siqueira; Santos, Silvia Reis dos; Abreu, Thalita; Oliveira, Ricardo Hugo S. de; Baptista, Denise Marcelino; Dantas, Marylane Christian Feitosa; Carvalho, Márcia; Guedes, Luciane Gaspar

doi:10.1590/s0066-782x2008000100003

Cited by 9 publications

(8 citation statements)

References 16 publications

(23 reference statements)

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“…Left ventricular systolic dysfunction was lower than what was reported in other studies among ART naïve children in Brazil (24.7% of 93 children) and earlier in Uganda (17% of 230 children) [7, 8]. ART reduces the viral load which in turn reduces myocardial invasion by cardiotropic viruses which would cause cardiac dysfunction [20].…”

Section: Discussionmentioning

confidence: 93%

Cardiac Dysfunction Among Ugandan HIV-infected Children on Antiretroviral Therapy

Namuyonga

Lubega

Musiime

et al. 2016

Pediatric Infectious Disease Journal

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Background Despite effective antiretroviral therapy (ART), HIV-infected children on treatment have been observed to have cardiac abnormalities. We sought to determine the prevalence, types and factors associated with cardiac abnormalities among HIV-infected Ugandan children on combination ART. Methods We carried out a cross-sectional study from July 2012 to January 2013, at Joint Clinical Research Centre among HIV infected children aged 1 to 18 years. Cardiac abnormalities were assessed using electrocardiography (EKG) and echocardiography. CD4 counts, viral load and complete blood count were performed at enrollment. The prevalence of cardiac abnormalities was determined using simple proportions with the associated factors ascertained using logistic regression. Results Among 285 children recruited, the median (IQR) age was 9 (6, 13) years, 54% were female; 72% were on first line cART. Their mean (±sd) CD4 count was 1092 (±868.7) cells/mm3; median (IQR) viral load was 20 (20, 76) copies/ml. 94% had adherence to ART of more than 95%. Cardiac abnormalities were detected in 39 (13.7%) children. The most common abnormalities by EKG and echocardiography were non specific T-wave changes (4.6%) and pericardial disease (thickened pericardium with or without pericardial effusion) (2.8%), respectively. No factor assessed was found to be significantly associated occurrence of cardiac dysfunction. Conclusions The prevalence of cardiac dysfunction among the HIV-infected children on ART was 13.7 % which was high, with non specific T wave changes and pericardial disease being the most frequent abnormalities observed. No factor assessed was found to be associated with cardiac dysfunction.

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Section: Discussionmentioning

confidence: 93%

Cardiac Dysfunction Among Ugandan HIV-infected Children on Antiretroviral Therapy

Namuyonga

Lubega

Musiime

et al. 2016

Pediatric Infectious Disease Journal

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“…The most common abnormalities found were left ventricular (LV) dilation and LV hypertrophy. 3 Cunha et al 4 found that LV dysfunction was common in Brazilian children approximately 18 months after acquired immune deficiency syndrome diagnosis. Their data suggest a much lower incidence of LV dysfunction in patients treated with ART.…”

mentioning

confidence: 99%

“…They also suggest that the observed decreased in cardiac disease with ART may in fact be a delay in the onset of cardiovascular manifestations of HIV. 4 …”

mentioning

confidence: 99%

Abnormal Cardiac Strain in Children and Young Adults with HIV Acquired in Early Life

Sims¹,

Frank²,

Cross³

et al. 2012

Journal of the American Society of Echocardiography

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Background Traditional measures of cardiac function are now often normal in adolescents and young adults treated with antiretroviral therapy for human immunodeficiency virus (HIV) infection. There is, however, evidence of myocardial abnormalities in adults with HIV. Cardiac strain analysis may detect impairment in cardiac function that may be missed by conventional measurements in this population. Methods This was a retrospective study in which echocardiograms of HIV-infected subjects (n = 28) aged 7 to 29 years who participate in a natural history study of HIV acquired early in life were analyzed and compared with matched controls. Standard echocardiographic measures, along with speckle tracking–derived strain and strain rate, were assessed. Results Among the HIV-infected subjects, the median CD4 count was 667 cells/mm3, and the mean duration of antiretroviral therapy was 14.6 years. Ejection fractions and fractional shortening were normal. There were no significant differences in measures of systolic or diastolic function between the groups. The HIV-infected group had borderline increased left ventricular mass indices. Global longitudinal and circumferential strain and strain rate, as well as global radial strain rate, were significantly impaired in the HIV-infected group compared with controls. There were no associations identified between left ventricular mass index or strain indices and current CD4 count, CD4 nadir, HIV viral load, or duration of antiretroviral therapy. Conclusions HIV-infected participants demonstrated impaired strain and strain rate despite having normal systolic function and ejection fractions. Strain and strain rate may prove to be prognostic factors for long-term myocardial dysfunction. Therefore, asymptomatic children and young adults with long-standing HIV infection may benefit from these more sensitive measures.

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“…No Brasil, acompanhando a tendência mundial, houve crescimento progressivo do número de casos em mulheres jovens, bem como da transmissão perinatal, que responde hoje por mais de 80% do total dos casos de síndrome de imunodeficiência adquirida (Aids) pediátricos notificados (1) . As crianças acometidas por infecção vertical têm um período clínico de latência menor e a progressão da doença é mais rápida (2) .…”

Section: Introductionunclassified

“…As crianças acometidas por infecção vertical têm um período clínico de latência menor e a progressão da doença é mais rápida (2) . O comprometimento cardíaco é decorrente da agressão causada pelo próprio HIV, além das infecções oportunistas, cardiotoxicidade causada pelas drogas antirretrovirais, deficiência nutricional e imunossupressão prolongada (1,(3)(4)(5)(6) . As principais manifestações cardíacas são miocardiopatia dilatada, derrame pericárdico, doença coronariana e insuficiência cardíaca congestiva (ICC) (4,7,8) .…”

Section: Introductionunclassified

O uso da L-carnitina como adjuvante no tratamento da miocardiopatia dilatada em criança com Aids

Zanoni

Oliveira

Consolo

et al. 2011

Rev. paul. pediatr.

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ResumOObjetivo: Apresentar a resposta cardiovascular à L-carnitina de um paciente com insuficiência cardíaca congestiva decorrente de miocardiopatia dilatada pelo vírus da imunodeficiência humana.Descrição do caso: Criança com quadro clínico de insuficiência cardíaca congestiva grave devido à miocardiopatia dilatada pela síndrome de imunodeficiência adquirida. O tratamento para as manifestações clínicas foi instituído, com pouca resposta clínica. Com objetivo de melhorar o desempenho energético/ metabólico dos cardiomiócitos, foi instituída terapia com Lcarnitina. Observou-se significativa melhora clínica do paciente, em relação ao desempenho cardíaco, mesmo antes do início do tratamento com os fármacos antirretrovirais.Comentários: A L-carnitina é um composto que facilita o transporte dos ácidos graxos de cadeia longa para dentro da mitocôndria. Nesse caso, o uso da L-carnitina parece ser clinica e bioquimicamente justificado.Palavras-chave: L-carnitina; cardiomiopatia dilatada; síndrome de imunodeficiência adquirida; criança. AbstRActObjective: To present the cardiovascular response to Lcarnitine of a patient with congestive heart failure caused by dilated cardiomyopathy and human immunodeficiency virus.Case description: Child with a clinical history of severe congestive heart failure due to dilated cardiomyopathy caused by acquired immunodeficiency syndrome. The treatment for the symptoms resulted in a poor clinical response. In order to improve the energetic performance/metabolism of cardiomyocytes, therapy with L-carnitine was established. There was significant clinical improvement of the cardiac performance of the patient, even before starting the treatment with antiretroviral drugs.Comments: L-carnitine is a compound that facilitates the transport of long-chain fatty acids into the mitochondria. In this case the administration of L-carnitine appears to be clinically and biochemical justified.

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AIDS na infância: acometimento cardíaco com e sem a terapia anti-retroviral tríplice combinada

Cited by 9 publications

References 16 publications

Cardiac Dysfunction Among Ugandan HIV-infected Children on Antiretroviral Therapy

Cardiac Dysfunction Among Ugandan HIV-infected Children on Antiretroviral Therapy

Abnormal Cardiac Strain in Children and Young Adults with HIV Acquired in Early Life

O uso da L-carnitina como adjuvante no tratamento da miocardiopatia dilatada em criança com Aids

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