Cardiac manifestations in HIV-infected Thai children

Abstract

Cardiac complications contribute significantly to morbidity and mortality in HIV-infected children. There have been few reports of cardiac manifestations in HIV-infected children in developing countries. The aims of this study were to evaluate the clinical manifestations and echocardiographic findings in Thai children with HIV infection and determine the clinical predictors of left ventricular dysfunction and pulmonary hypertension. We retrospectively reviewed the medical records of 27 infants infected with HIV perinatally who presented with cardiovascular problems at a tertiary care hospital between 1995 and 2000. The mean age at initial cardiac evaluation was 36 months (range 8-65). Signs and symptoms included dyspnoea in all cases, oedema in 12 (44%), finger clubbing in 11 (41%), cyanosis in 6 (22%) and S(3) gallop in 8 (30%). Echocardiographic abnormalities included pericardial effusion in 12 (44 %), right ventricular dilatation in 12 (44%), pulmonary hypertension in 11 (41%), diminished left ventricular fractional shortening in 10 (37%), left ventricular dilatation in 9 (33%) and combined ventricular dilatation in 2 (7%). Left ventricular dysfunction did not correlate with HIV CDC classification, age, nutritional status or clinical signs and symptoms.

Pathology of Pulmonary Hypertension

“…For HIV-related pulmonary hypertension, the first clinical report of an association between infection and the development of lesions appeared in 1987 [84], followed by other reports [85][86][87] but with no evidence for the presence of the virus in PH vascular lesions. As PH is frequently diagnosed when it is advanced, the incidence of PH in HIV-infected patients is likely underestimated, although a recent report demonstrates a high prevalence of PH in HIV-infected children [88]. BMPR2 mutations are not required for severe PH to occur in HIV-infected patients, yet the vascular lesions in the lungs from HIV-infected [86] patients are identical to those with familial PH and sporadic IPAH with BMPR2 mutations.…”

Pulmonary Arterial Hypertension from a Pediatric Perspective

“…A recent report finds a high prevalence of PAH in children infected with HIV [68]. The virus itself has never been found in the lungs of patients with PAH, suggesting that HIV acts indirectly on the endothelial cells by producing growth factors and cytokines [69].…”

Genomics of Pulmonary Arterial Hypertension: Implications for Therapy

“…For HIV-related pulmonary hypertension, the first clinical report of an association between infection and the development of lesions appeared in 1987 (78), followed by other reports (79–81) but with no evidence for the presence of the virus in PH vascular lesions. As PH is frequently diagnosed when it is advanced, the incidence of PH in HIV-infected patients is likely underestimated, although a recent report demonstrates a high prevalence of PH in HIV-infected children (82). BMPR2 mutations are not required for severe PH to occur in HIV-infected patients, yet the vascular lesions in the lungs from HIV-infected (80) patients are identical to those with familial PH and sporadic IPAH with BMPR2 mutations.…”