Echocardiographic Follow-up of Perinatally HIV-infected Children and Adolescents

Abstract

Background: The effects of HIV and antiretroviral therapy on cardiovascular system of perinatally infected children throughout their development are not fully understood. Objectives: To determine the prevalence of cardiac abnormalities in a retrospective cohort of perinatally HIV-infected patients and to investigate associations between echocardiographic and clinical data during their follow-up. Methods: Review of medical records and echocardiogram reports of 148 perinatally HIV-infected patients between January 1991 and December 2015. Results: Four hundred and eighty echocardiograms were analyzed and 46 (31%) patients showed cardiac abnormalities, frequently subclinical and transient. Nadir CD4 count was higher in patients with consistently normal echocardiogram: 263 (4–1480) versus 202 (5–1746) cells/μL, P = 0.021. Right ventricular (RV) dilation was detected in 18.9%, left ventricular (LV) dilation in 21.6%, septal hypertrophy in 12.2%, LV posterior wall hypertrophy in 6%, LV systolic dysfunction in 8% and pulmonary hypertension in 8.7% of patients. Opportunistic infections were associated with RV dilation [odds ratio (OR = 4.34; 1.78–10.53; P < 0.01)], pulmonary hypertension (OR = 8.78; 2.80–27.51; P < 0.01) and LV systolic dysfunction (OR = 5.38; 1.55–18.71; P < 0.01). Longer duration of highly active antiretroviral therapy was associated with reduced risk of LV dilation (OR = 0.91; 0.85–0.97; P < 0.01) and systolic dysfunction (OR = 0.71; 0.59–0.85; P < 0.01). Protease inhibitors use was associated with reduced risk of RV dilation (OR = 0.54; 0.30–0.97; P < 0.05), LV dilation (OR = 0.35; 0.21–0.60; P < 0.01) and LV systolic dysfunction (OR = 0.07; 0.02–0.31; P < 0.01). Higher CD4 count was associated with lower risk of LV systolic dysfunction (OR = 0.82; 0.69–0.98; P < 0.05). Conclusions: Echocardiograms identified cardiac abnormalities among children with perinatally acquired HIV infection, and data suggest that immunologic status and therapeutic strategies throughout development can influence cardiac disease burden in this population.

Cardiovascular effects of intrauterine exposure to maternal HIV and antiretroviral therapy in Ethiopian infants followed from fetal life

“…Similar to adult PWH, HIV-positive children are also at higher risk of CVD [40][41][42]. Cardiac remodeling and dysfunction, linked to immunologic status and ART exposure throughout development [43,44], have been observed among children with perinatally acquired HIV infection, as well as increased cIMT, a predictor for future atherosclerosis [45].…”

Subclinical cardiac disease in children with perinatally acquired HIV is associated with inflammation

“…Growing evidence suggests that despite viral suppression, suboptimal inflammation still persists [6,7] and contributes to the genesis and progression of subclinical cardiac disease in more than 25% of children with PHIV [8,9]. Structural and functional cardiac abnormalities on echocardiographic findings reported in children with PHIV include right ventricular (RV) and left ventricular (LV) dilation, septal hypertrophy, LV posterior wall hypertrophy, LV systolic dysfunction, reduced LV global longitudinal strain, and higher end-systolic wall stress [5,8,9].…”