Need for active cardiovascular screening in HIV-infected children under antiretroviral therapy in Africa

Abstract

Unacceptably high incidence of pediatric HIV despite worldwide increased access to antiretroviral therapy. The routine management of these children includes provision of antiretroviral therapy, and periodic assessment of its results and complications. However, no systematic assessment of the nutritional status, lipid profile or screening for cardiovascular disease is done. Our study aimed at describing the occurrence of cardiovascular abnormalities in HIV-infected children under antiretroviral therapy, and at determining the vital outcomes 5 years after. A prospective observational study was implemented at a dedicated HIV center in Maputo City, where we gathered detailed socio-demographic data and performed full cardiovascular evaluation, including transthoracic cardiac ultrasound. A total of 47 children were examined (24 male) of which 10 had abnormal cardiac ultrasound: impaired systolic function (5 children); three had congenital heart defects; one had severe rheumatic aortic regurgitation and one had tuberculous pericarditis. Heart failure was present in five children. The study also uncovered the presence of malnutrition (36 patients; 80% had BMI below 18.5 kg/m 2) and anemia in a considerable proportion of children. On 5 year follow up there was one death due to malária; three new cases of left ventricular dysfunction occurred among children who had normal ultrasound on recruitment. Our results support systematic cardiovascular risk profiling and disease screening in HIV-infected children on antiretroviral therapy, using cardiac ultrasound wherever possible.

Letter to the Editor: Cardiac Dysfunction Among Youth With Perinatal HIV Acquisition and Exposure

“…Our chief findings confirm that the prevalence of cardiac dysfunction by echocardiogram is higher than previously reported from the region and that HEU group status is associated with abnormal MPI in multivariate modeling adjusted for age. 12–15 This study adds to the literature by comparing the burden of cardiac disease in PHIV to 2 important comparator groups, and shows that PHIV and HEU had a high proportion of individuals with abnormal cardiac imaging. In addition, we focused on an early measure of cardiac dysfunction—MPI—which can detect subtle abnormalities before overt cardiac dysfunction.…”

Prevalence and Impact of HIV Infections in Patients with Rheumatic Heart Disease: A Systematic Review and Meta-Analysis

“…Early management of HIV may also be required to achieve viral and immunological controls to allow for optimal post-surgery recovery [82]. An unacceptably high rate of RHD overlaps with perinatal HIV transmission in Mozambique [54], Uganda [52,53], and many LMICs. HIV-infected as well as exposed seronegative children may also have an entirely different response to GAS infection and RHD and may therefore require deeper investigations.…”

HIV infection and cardiovascular pathology

“…В течение шести лет наблюдения за женщинами с ВИЧ-инфекцией, не имевших исходно ССЗ, было показано, что они имели в 2,8 раза больший риск их развития, среди них была выше смертность от ССЗ, по сравнению с женщинами без ВИЧ-инфекции [13]. По результатам африканского исследования ВИЧ-инфицированных детей, принимающих АРТ, была установлена необходимость скрининга ССЗ в данной группе в связи с высоким риском развития у них СН [14].…”