Cardiac Manifestations in HIV Infected Children. Are they under Diagnosed?

Abstract

Background: The aim of this study was to evaluate cardiac manifestations in HIV-infected children in India. Methods & Results: This was a cross sectional study in HIV positive children up to 18 years of age, at a pediatric HIV clinic of a tertiary care teaching hospital in Maharashtra, India. All children were thoroughly evaluated by detailed history, clinical examination and underwent chest radiograph, Electrocardiograph (ECG) and Echocardiography (Echo). Of the 119 children who completed the study, the male to female ratio was 1.16:1 and the mean age was 8.9 years (range 2-17 years). Cardiovascular abnormalities were detected in 74 (62%) children on echo and / or ECG. Echocardiography alone was abnormal in 44 (36.9%) children and ECG alone was abnormal in 56 (47%) children. However, only 11(9%) children were found to be symptomatic with cardiovascular symptoms. The prevalence of Congenital Heart Disease (CHD) was 4%. The most common ECG abnormality observed in the study was sinus tachycardia in 35 (29%) followed by ST-T changes in 20 (16.8%).The most common echocardiographic abnormality encountered was LV systolic dysfunction seen in 31 (26%) cases, followed by Low LV ejection fraction in 24 (20%) cases. Children with abnormal echo and ECG were in higher WHO clinical and immunological stages (III & IV), however the association between the two was not found to be statistically significant. Conclusions: This study establishes that subclinical cardiac manifestations are prevalent in HIV infected children. More research should be done on the clinical significance of these findings and the need for long-term follow up.

Left ventricular hypertrophy in African children infected with HIV/AIDS: a case control study

“…Left ventricular hypertrophy in this index study were noted to occur in the younger age below seven years. Other studies have documented similar finding [ 8 , 20 ]. This age group may be at higher risk for HIV-associated cardiac abnormalities for these reasons.…”

“…This age group may be at higher risk for HIV-associated cardiac abnormalities for these reasons. The vertical transmission of HIV infection; which occurs in utero or at delivery may have caused cardiac developmental abnormality or given ample time for the virus to cause changes on the myocytes [ 20 ].…”

“…Also, the immaturity of cardiac structures associated with younger age and the use of HAART are possible reasons for this observation [ 8 ]. Left ventricular hypertrophy is a useful predictor of mortality risk in children with HIV-infection/AIDS [ 20 ]. This risk is higher with concentric LVH type.…”

Korelasi Cluster of Differentiation 4 dan Viral Load dengan Fungsi Sistolik Ventrikel Kiri pada Anak dengan Human Immunodeficiency Virus

“…Gangguan fungsi sistolik ventrikel kiri dapat dinilai salah satunya melalui pemeriksaan echocardiography, parameter yang diukur adalah pemendekan fraksi dan fraksi ejeksi. [1][2][3][4][19][20][21][22] Nilai pemendekan fraksi dan fraksi ejeksi bervariasi pada beberapa penelitian, di antaranya adalah penelitian Hsue 17 dengan nilai fraksi ejeksi 33-49%, Reinsch 18 dengan nilai fraksi ejeksi 20-54%, Badal 3 dengan nilai pemendekan fraksi 33,4±6,41% dan fraksi ejeksi 60,7±6,54%, serta Arodiwe dkk 1 dengan nilai pemendekan fraksi 31,6-35,3% dan fraksi ejeksi 45,3-53,3%. Nilai rata-rata pemendekan fraksi pada penelitian ini adalah 35,8%±5,0% serta fraksi ejeksi 65,7%±6,8%.…”

“…Salah satu kerusakan organ yang dapat terjadi adalah gangguan kardiovaskuler. [3][4][5][6][7] Penyebab manifestasi gangguan kardiovaskuler pada anak dengan HIV belum dapat ditentukan, tetapi kemungkinan penyebabnya multifaktorial, di antaranya depresi sistem imun berkepanjangan, infeksi oportunistik, penggunaan obat-obatan, respon autoimun, maupun malnutrisi. Sebuah penelitian multisenter prospektif, yaitu The Prospective Pediatric Pulmonary and Cardiac Complications Study of HIV (P 2 C 2 ), menunjukkan bahwa gangguan kardiovaskuler banyak ditemukan pada anak dengan HIV.…”