Cardiac Complications in Children With Human Immunodeficiency Virus Infection

Abstract

Objective-Although numerous cardiac abnormalities have been reported in HIV-infected children, precise estimates of the incidence of cardiac disease in these children are not wellknown. The objective of this report is to describe the 2-year cumulative incidence of cardiac abnormalities in HIV-infected children.Methodology: Design-Prospective cohort (Group I) and inception cohort (Group II) study design.Setting-A volunteer sample from 10 university and public hospitals.Participants-Group I consisted of 205 HIV vertically infected children enrolled at a median age of 22 months. This group was comprised of infants and children already known to be HIVinfected at the time of enrollment in the study. Most of the children were African-American or Copyright © 1999 by the American Academy of Pediatrics.Reprint requests to (T.J.S.) Babies and Children's Hospital-2 North, Columbia-Presbyterian Medical Center, 630 W 168th St, New York, NY 10032., tjs1@columbia.edu. a Dr Lipshultz' current affiliation is with the Division of Pediatric Cardiology, Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY.This study was presented in part at the Society for Pediatric Research, May 10, 1995; San Diego, CA. HHS Public Access Author manuscriptPediatrics. Author manuscript; available in PMC 2015 March 13. Published in final edited form as:Pediatrics. 1999 August ; 104(2): e14. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptHispanic and 89% had symptomatic HIV infection at enrollment. The second group included 611 neonates born to HIV-infected mothers, enrolled during fetal life or before 28 days of age (Group II). In contrast to the older Group I children, all the Group II children were enrolled before their HIV status was ascertained.Interventions-According to the study protocol, children underwent a series of cardiac evaluations including two-dimensional echocardiogram and Doppler studies of cardiac function every 4 to 6 months. They also had a 12-or 15-lead surface electrocardiogram (ECG), 24-hour ambulatory ECG monitoring, and a chest radiograph every 12 months.Outcome Measures-Main outcome measures were the cumulative incidence of an initial episode of left ventricular (LV) dysfunction, cardiac enlargement, and congestive heart failure (CHF). Because cardiac abnormalities tended to cluster in the same patients, we also determined the number of children who had cardiac impairment which we defined as having either left ventricular fractional shortening (LV FS) ≤25% after 6 months of age, CHF, or treatment with cardiac medications.Results: Cardiac Abnormalities-In Group I children (older cohort), the prevalence of decreased LV function (FS ≤25%) was 5.7% and the 2-year cumulative incidence (excluding prevalent cases) was 15.3%. The prevalence of echocardiographic LV enlargement (LV enddiastolic dimension z score >2) at the time of the first echocardiogram was 8.3%. The cumulative incidence of LV enddiastolic enlargement was 11.7% after 2 years.The cumulative incidence of...

Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2 C2 HIV study

“…Echocardiograms were performed according to a protocol in 10 pediatric cardiology laboratories at the 5 centers as previously described. 1,11,12 A total of 5026 echocardiograms were performed and 4732 were measured at the central echocardiography laboratory at the Boston Children's Hospital. We excluded left ventricular (LV) measurements of 109 echocardiograms from 72 children who had segmental wall abnormalities or abnormal interventricular septal motion because these conditions can affect the LV function measurements.…”

“…1,9 Of the 600 live-born infants in group II, 93 were HIV infected, 463 remained uninfected, and 44 had indeterminate HIV status.…”

“…Our group previously reported that over the first 2 years of observation, 10% of HIV-infected children either had congestive heart failure (CHF) or required treatment with cardiac medications or both. 1 In addition, 20% of HIV-infected children had cardiac dilation or dysfunction. 1 We also reported that over the entire 6-year observation period of our study, cardiac abnormalities were the underlying cause of HIV-related death in 11 (11.8%) of 93 children and were a contributing cause in an additional 22%.…”

“…1 In addition, 20% of HIV-infected children had cardiac dilation or dysfunction. 1 We also reported that over the entire 6-year observation period of our study, cardiac abnormalities were the underlying cause of HIV-related death in 11 (11.8%) of 93 children and were a contributing cause in an additional 22%. 2 Furthermore, baseline cardiac dysfunction was a risk factor for death independent of CD4 count, wasting, and other predictors of death.…”

“…3 Our previous report detailing the incidence of cardiac complications in HIV-infected children was limited to the first 2 years of observation in the P 2 C 2 HIV study. 1 The majority of other published studies of cardiac dysfunction in HIV-infected children have been crosssectional or short-term descriptions. [4][5][6][7][8] Because HIV infection often becomes a chronic condition, information regarding the long-term outcomes of HIV-infected children is needed.…”