PPubMed18 Jun 2013Cited 59×

Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: a view from the United States of America

Steven E Lipshultz, Tracie L Miller, James D Wilkinson, Gwendolyn B Scott, Gabriel Somarriba, Thomas R Cochran, Stacy D Fisher

Abstract

Before HAART therapy, the two-to-five-year incidence of symptomatic heart failure ranged from 4 to 28% in HIV patients, suggesting a prevalence of symptomatic HIV-related heart failure of between 4 and 5 million cases worldwide . The incidence of clinically important cardiac disease in HIV-infected patients has been markedly reduced by HAART. However, HAART is only available to a minority of those in need . Patients receiving HAART also frequently have asymptomatic abnormalities in cardiac structure . Echocardiographic measurements indicate 18% have LV systolic dysfunction, 6.5% have LV hypert

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HIV-infected and exposed children face high rates of cardiac dysfunction, including diastolic dysfunction (up to 37%), pulmonary hypertension (0.5%), and pericardial disease (11%/year), despite HAART reducing some risks.

What’s new

i.Summarizes prevalence of HIV‑associated cardiac diseases in perinatally infected and exposed children
ii.Provides imaging evidence of increased atherosclerosis markers in HIV‑infected youth
iii.Details drug–cardiac interactions specific to antiretroviral therapies
iv.Highlights growth and cardiac effects of perinatal HIV exposure

How they did it

The authors performed a narrative review of existing clinical studies, imaging reports, and drug‑interaction data concerning perinatally HIV‑infected and HIV‑exposed but uninfected children and adolescents in the United States. Information was extracted from cohort studies, case series, and meta‑analyses and organized into tables summarizing disease prevalence, diagnostic modalities, and therapeutic considerations.

What they found

LV diastolic dysfunction observed in up to 37% of asymptomatic HIV‑infected youth
Pulmonary hypertension prevalence 0.5% in the cohort
Pericardial disease incidence 11% per year, with pericardial effusions in up to 22% after 25 months in pre‑HAART era
HAART‑treated patients showed markedly reduced pericardial effusion incidence (2/802 patients)
Carotid intima‑media thickness 0.04 mm greater in HIV‑infected versus controls
HIV‑infected children have higher mean Agatston calcium scores and greater proportion of scores >0
Mother‑to‑child transmission in the US reduced to ~1‑2%

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