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.

À minha orientadora, Dra. Gabriela Nunes Leal, por ter acreditado neste trabalho desde o início e ter me guiado durante todas as etapas desse projeto. Agradeço imensamente pela confiança, paciência e ensinamentos que obtive ao longo deste trabalho. Aos médicos da equipe da Infectologia Pediátrica do Instituto da Criança do Hospital das Clínicas-FMUSP, em especial à Dra. Heloisa Helena de Sousa Marques pelo apoio e incentivo deste projeto. Aos médicos do Departamento de Ecocardiografia do Instituto da Criança do Hospital das Clínicas-FMUSP pelo trabalho e dedicação na realização de tantos ecocardiogramas ao longo destes anos. Ao meu marido, Luiz Felipe Paiva Lazarini, pelo incentivo a dar início a este trabalho e por toda paciência durante todos os meus anos de estudo. À minha família, em especial aos meus pais Luiz Claudio Vallilo e Maria Rosa Gaspar Vallilo, por me apoiarem e permitirem a seguir a carreira médica e estarem do meu lado nos momentos mais difíceis. Agradecimento mais que especial para a pessoa que chegou em minha vida há poucos meses, virou minha vida do avesso, mas com toda a certeza me tornou uma pessoa melhor. Meu amor, meu filho Joaquim. Esta dissertação está de acordo com as seguintes normas, em vigor no momento desta publicação: Referências: adaptado de International Committee of Medical Journals Editors (Vancouver).

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