Original ArticlesIncidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2 C2 HIV study☆,☆☆
Section snippets
Study design
A total of 805 children born to HIV-infected mothers were studied at 10 hospitals in 5 centers (see Appendix). Each center's institutional review board approved the study, and patients were enrolled after informed consent was obtained.9
Study cohorts
Group I included 205 vertically HIV-infected children. They entered the study between 1990 and 1993 at a median age of 1.9 years (range, 0.1-14 years), and 89% had symptomatic HIV infection by Centers for Disease Control and Prevention (CDC) classification10 at
Demographics
Group I consisted of 205 HIV-infected children of whom 89% had symptomatic HIV infection at enrollment.1, 9 Of the 600 live-born infants in group II, 93 were HIV infected, 463 remained uninfected, and 44 had indeterminate HIV status.
Cardiac size and function (group I, older children)
After excluding prevalent cases, the cumulative incidence of LV dysfunction (LVFS, 19%-25%) after 5 years in the study was 28.0% (Table I).Cardiomegaly (LV end-diastolic [LVED] dimension Z score >2) was seen in 21.7% after 5 years. Cardiomegaly on chest radiography
Discussion
Our study shows that cardiac dysfunction occurs frequently in children with HIV infection and that these children have cardiac abnormalities ranging from asymptomatic cardiac dilation to severe CHF. The relative risk of death during the 5-year follow-up period in children who had cardiac impairment or CHF was 8.5 to 14.6 times higher than in the children without these complications. Our study also shows that CHF and cardiac impairment are important risk factors for death in HIV-infected
References (30)
- et al.
Cardiac manifestations of human immunodeficiency virus infection in infants and children
Am J Cardiol
(1989) - et al.
Developmental modulation of myocardial mechanics: age-and-growth-related alterations in afterload and contractility
J Am Coll Cardiol
(1992) - et al.
Limitations of fractional shortening as an index of contractility in pediatric patients infected with human immunodeficiency virus
J Pediatr
(1994) - et al.
Effect of zidovudine and didanosine treatment on heart function in children infected with human immunodeficiency virus
J Pediatr
(1995) - et al.
Identification of human immunodeficiency virus-1 RNA and DNA in the heart of a child with cardiovascular abnormalities and congenital acquired immune deficiency syndrome
Am J Cardiol
(1990) - et al.
The detection of viral genomes by polymerase chain reaction in myocardium of pediatric patients with advanced HIV disease
J Am Coll Cardiol
(1999) - et al.
Cardiac complications in children with human immunodeficiency virus infection [electronic citation
- et al.
Human immunodeficiency virus-related mortality in infants and children: data from the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV (P2 C2) Study
Pediatrics
(2001) - et al.
Cardiac dysfunction and mortality in HIV-infected children: the Prospective P2 C2 HIV Multicenter Study
Circulation
(2000) - et al.
Cardiac morbidity and related mortality in children with HIV infection
JAMA
(1993)
Cardiac involvement in congenital acquired immunodeficiency syndrome
Am J Dis Child
Cardiac disease in children with HIV: relationship of cardiac disease to HIV symptomatology
Pediatr AIDS HIV Infect
Characteristics of human immunodeficiency virus-infected children at the time of death: an experience in the 1990s
Pediatr Infect Dis J
The pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus (P2 C2 HIV) infection study: design and methods
J Clin Epidemiol
Centers for Disease Control and Prevention 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age
MMWR Morb Mortal Wkly Rep CDC Surveill Summ
Cited by (69)
Echocardiographic Findings in a Cohort of Perinatally HIV-Infected Adolescents Compared with Uninfected Peers from the Cape Town Adolescent Antiretroviral Cohort
2020, Journal of the American Society of EchocardiographyCitation Excerpt :Only 86% of these children were on ART. LV diastolic dysfunction was not evaluated during the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection study and Cardiac Highly Active Antiretroviral Therapy study.21,24 Among PHIV+ adolescents, we found an association between E/A ratio and being in WHO HIV stage IV at initiation of ART.
Biventricular diastolic function assessed by Doppler echocardiogram in children vertically infected with human immunodeficiency virus
2014, Jornal de PediatriaCitation Excerpt :In a prospective study, the cumulative five-year incidence of cardiac dysfunction in children ranged from 18% to 39%, and was the HIV-related cause of death in 11.8%.1–4 Subclinical cardiac abnormalities may develop in early HIV infection, even among individuals with asymptomatic disease or without cardiac dysfunction.1,4–9 The resolution of dilated cardiomyopathy in vertically infected children has been reported in those treated with a combination of drugs.6,10–12
Cardiac Diseases
2012, Anesthesia and Uncommon Diseases: Sixth EditionAcquired Immune Dysfunction
2011, Pediatric Critical Care: Expert Consult Premium EditionAcquired Immune Dysfunction
2011, Pediatric Critical Care
- ☆
Supported by the National Heart, Lung, and Blood Institute (NO1-HR-96037, NO1-HR-96038, NO1-HR-96039, NO1-HR-96040, NO1-HR-96041, NO1-HR-96042, and NO1-HR-96043) and in part by the National Institutes of Health General Clinical Research Center Grants (RR-00865, RR-00188, RR-02172, RR-00533, RR-00071, RR-00645, RR-00685, and RR-00043).
- ☆☆
Reprint requests: Thomas J. Starc, MD, MPH, 630 W 168th St, Babies and Children's Hospital, 2 North, Room 260, Columbia-Presbyterian Medical Center, New York, NY 10032.