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

Abstract

Objective-To describe the 5-year cumulative incidence of cardiac dysfunction in human immunodeficiency virus (HIV)-infected children.Study design-We used a prospective cohort design, enrolling children at 10 hospitals. Group I included 205 vertically HIV-infected children enrolled at a median age of 1.9 years. Group II consisted of 600 HIV-exposed children enrolled prenatally or as neonates, of whom 93 were ultimately HIV-infected. The main outcome measures were echocardiographic indexes of left ventricular dysfunction.Results-In group I, the 5-year cumulative incidence of left ventricular fractional shortening ≤25% was 28.0%. The 5-year incidence of left ventricular end-diastolic dilatation was 21.7%, and heart failure and/or the use of cardiac medications 28.8%. The mortality rate 1 year after the diagnosis of heart failure was 52.5% [95% CI,. Within group II, the 5-year cumulative incidence of decreased fractional shortening was 10.7% in the HIV-infected compared with 3.1% in the HIV-uninfected children (P = .01). Left ventricular dilation, heart failure, and/or the use of cardiac medications were more common in infected compared with uninfected children. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusions-During 5 years of follow-up, cardiac dysfunction occurred in 18% to 39% of HIV-infected children and was associated with an increased risk of death. We recommend that HIV-infected children undergo routine echocardiographic surveillance for cardiac abnormalities.Human immunodeficiency virus (HIV) infection continues to be an important cause of morbidity and mortality in children. We designed the Pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus infection (P 2 C 2 ) HIV study to determine the incidence of heart and lung abnormalities in HIV-infected children. This study began in 1990 and data collection continued through January 1997. 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%. 2 Furthermore, baseline cardiac dysfunction was a risk factor for death independent of CD4 count, wasting, and other predictors of death. 3Our 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 c...

Cardiovascular complications in patients with HIV infection

“…The relative risk for death during the 5-year follow-up period is 8.5 to 14.6 times higher than in children without these complications [7]. Results from the P 2 C 2 HIV study show increasingly abnormal LV structure and function in the first 3 years of life, resulting in persistent mild LV dysfunction and increased LV mass.…”

Age and gender specific prevalence of HTLV-1

“…For female donors overall, the older age subgroups had significantly higher HTLV-1 seroprevalence compared with younger subgroups in all pair-wise comparisons (p < 0.0001) except between G [16][17][18][19] and G [20][21][22][23][24][25][26][27][28][29] (Table 1). This trend was also observed for male donors, where G [16][17][18][19] and G 20-29 were not significantly different and all other pair-wise comparisons showed significantly higher seroprevalence for older subgroups (p = 0.0087 between G 20-29 and G 30-39 , and p < 0.0001 for all other pair-wise comparisons, Table 1).…”

“…However, a study conducted on ∼1800 infants born to HCV-infected mothers demonstrated twice as much vertical transmission to females as males. 23 For HIV, intra-uterine infection is reported to be female dominant, [24][25][26][27][28] whereas post-natal infection is more common for males. 29,30 One might speculate that the gender-specific risk of transmission varies according to the transmission route.…”

AIDS na infância: acometimento cardíaco com e sem a terapia anti-retroviral tríplice combinada

“…The applicability of data previously published about the cardiac involvement in patients using protease inhibitors is unknown, and it is necessary to verify if this new therapy has modified the incidence of cardiac manifestations 10 . This current study aims to describe the cardiac clinical manifestations, results of laboratory tests that evaluate the immunological status and echocardiographic findings after 18±6 months of AIDS diagnosis, trying to relate them to the type of antiretroviral therapy available.…”

“…The severity of dysfunction was quantified by Δ% LV, that is, the lower the percentage, the more severe the left ventricular involvement. Values of 28% to 25% were considered mild dysfunction and, in most cases, patients were asymptomatic; values <25% and up to 19% were considered as moderate dysfunction, usually with clinical symptoms, and values lower than 19% were considered as severe dysfunction, almost always associated with a clinical picture of more severe heart failure 10 .…”