Elsevier

The Journal of Pediatrics

Volume 141, Issue 3, September 2002, Pages 327-335
The Journal of Pediatrics

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

https://doi.org/10.1067/mpd.2002.126301Get rights and content

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, 30.5-74.5]. 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. Conclusions: 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. (J Pediatr 2002;141:327-35)

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)

  • LJ Steinherz et al.

    Cardiac involvement in congenital acquired immunodeficiency syndrome

    Am J Dis Child

    (1986)
  • MA Grenier et al.

    Cardiac disease in children with HIV: relationship of cardiac disease to HIV symptomatology

    Pediatr AIDS HIV Infect

    (1994)
  • R Johann-Liang et al.

    Characteristics of human immunodeficiency virus-infected children at the time of death: an experience in the 1990s

    Pediatr Infect Dis J

    (1997)
  • P2 C2 HIV Study Group

    The pediatric pulmonary and cardiovascular complications of vertically transmitted human immunodeficiency virus (P2 C2 HIV) infection study: design and methods

    J Clin Epidemiol

    (1996)
  • 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

    (1994)
  • 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 Echocardiography
      Citation 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 Pediatria
      Citation 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 Edition
    • Acquired Immune Dysfunction

      2011, Pediatric Critical Care: Expert Consult Premium Edition
    • Acquired Immune Dysfunction

      2011, Pediatric Critical Care
    View all citing articles on Scopus

    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.

    View full text