Cardiac Effects of Antiretroviral-Naïve versus Antiretroviral-Exposed HIV Infection in Children

Background

Cardiac involvement in HIV infected children has been frequently reported, but whether this is due to HIV infection itself or to antiretroviral treatment (ART) is unknown.

Methods

This cross sectional study involved 114 vertically-acquired HIV-infected (56 ART-naive, 58 ART-exposed) and 51 healthy children in Jakarta, Indonesia. Echocardiography was performed to measure dimensions of the left ventricle (LV) and systolic functions. We applied general linear modeling to evaluate the associations between HIV infection/treatment status and cardiac parameters with further adjustment for potential confounders or explanatory variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children, with 95% confidence intervals and p values.

Results

Compared to healthy children, ART-naïve HIV-infected children did not show significant differences in age-and-height adjusted cardiac dimensions apart from larger LV internal diameter (difference 2.0 mm, 95%CI 0.2 to 3.7), whereas ART exposed HIV infection showed thicker LV posterior walls (difference = 1.1 mm, 95%CI 0.5 to 1.6), larger LV internal diameter (difference = 1.7 mm, 95%CI 0.2 to 3.2) and higher LV mass (difference = 14.0 g, 7.4 to 20.5). With respect to systolic function, reduced LV ejection fraction was seen in both ART-naïve HIV infected (adjusted difference = -6.7%, -11.4 to -2.0) and, to a lesser extent, in ART-exposed HIV infected children (difference = -4.5%, -8.5 to -0.4). Inflammation level seemed to be involved in most associations in ART-exposed HIV-infected, but few, if any, for decreased function in the ART-naive ones, whereas lower hemoglobin appeared to partially mediate chamber dilation in both groups and reduced function, mainly in ART-exposed children.

Conclusions

ART-naive HIV infected children have a substantial decrease in cardiac systolic function, whereas the ART-exposed have thicker ventricular walls with larger internal diameter and higher mass, but less functional impairment.

Below: Influence of potential explanatory variables on cardiac structural estimates in ART-naive and ART-exposed HIV infected children.  Note: LVPWd = left ventricular posterior wall thickness at end-diastole; LVIDd = left ventricular internal diameter at end-diastole; LV mass = left ventricular mass; RWT = relative wall thickness; Hb = hemoglobin level; BP = systolic and diastolic blood pressure.

Below:  Influence of potential explanatory variables on cardiac functional estimates in ART-naive and ART-exposed HIV infected children.  Note: EF = ejection fraction; FS = fractional shortening; TAPSE = tricuspid annular plane systolic excursion; Hb = hemoglobin level; BP = systolic and diastolic blood pressure.

Full article at:   http://goo.gl/epfyuV

By:  

Nikmah S. Idris, Nia Kurniati

Department of Child Health, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Nikmah S. Idris, Diederick E. Grobbee, Cuno S. P. M. Uiterwaal

Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, Netherlands

Nikmah S. Idris, Michael M. H. Cheung, David Burgner

Department of Pediatrics, University of Melbourne; Heart Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia

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