Left Ventricular Structure and Function in Children Infected With Human Immunodeficiency Virus
- 7 April 1998
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 97 (13), 1246-1256
- https://doi.org/10.1161/01.cir.97.13.1246
Abstract
Background —The frequency of, course of, and factors associated with cardiovascular abnormalities in pediatric HIV are incompletely understood. Methods and Results —A baseline echocardiogram (median age, 2.1 years) and 2 years of follow-up every 4 months were obtained as part of a prospective study on 196 vertically HIV-infected children. Age- or body surface area–adjusted z scores were calculated by use of data from normal control subjects. Although 88% had symptomatic HIV infection, only 2 had CHF at enrollment, with a 2-year cumulative incidence of 4.7% (95% CI, 1.5% to 7.9%). All mean cardiac measurements were abnormal at baseline (decreased left ventricular fractional shortening [LV FS] and contractility and increased heart rate and LV dimension, mass, and wall stresses). Most of the abnormal baseline cardiac measurements correlated with depressed CD4 cell count z scores and the presence of HIV encephalopathy. Heart rate and LV mass showed significantly progressive abnormalities, whereas FS and contractility tended to decline. No association was seen between longitudinal changes in FS and CD4 cell count z score. Children who developed encephalopathy during follow-up had depressed initial FS, and FS continued to decline during follow-up. Conclusions —Subclinical cardiac abnormalities in HIV-infected children are common, persistent, and often progressive. Dilated cardiomyopathy (depressed contractility and dilatation) and inappropriate LV hypertrophy (elevated LV mass in the setting of decreased height and weight) were noted. Depressed LV function correlated with immune dysfunction at baseline but not longitudinally, suggesting that the CD4 cell count may not be a useful surrogate marker of HIV-associated LV dysfunction. However, the development of encephalopathy may signal a decline in FS.Keywords
This publication has 33 references indexed in Scilit:
- A Random-Effects Model for Multiple Characteristics with Possibly Missing DataJournal of the American Statistical Association, 1997
- The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart FailureNew England Journal of Medicine, 1996
- Effect of zidovudine and didanosine treatment on heart function in children infected with human immunodeficiency virusThe Journal of Pediatrics, 1995
- Encephalopathy in children with perinatally acquired human immunodeficiency virus infectionThe Journal of Pediatrics, 1995
- Features of children perinatally infected with HIV-1 surviving longer than 5 years: Italian Register for HIV Infection in ChildrenThe Lancet, 1994
- Survival experience of 789 children with the acquired immunodeficiency syndromeThe Pediatric Infectious Disease Journal, 1993
- Prognostic factors and survival in children with perinatal HIV-1 infectionThe Lancet, 1992
- Identification of human immunodeficiency virus-1 RNA and DNA in the heart of a child with cardiovascular abnormalities and congenital acquired immune deficiency syndromeThe American Journal of Cardiology, 1990
- Cardiovascular manifestations of human immunodeficiency virus infection in infants and childrenThe American Journal of Cardiology, 1989
- Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findingsThe American Journal of Cardiology, 1986