Abstract:
BACKGROUND : Antiretroviral therapy (ART) has decreased mortality so that increasing
numbers of children with HIV are reaching adolescence. However, longstanding HIV
infection and/or its treatment in children is associated with noninfectious complications
including cardiac disease. We investigated the prevalence, spectrum and risk factors for
echocardiographic abnormalities among children established on ART.
METHODS : HIV-infected children aged 6–16 years, on ART at least 6 months were
enrolled into a cross-sectional study from a public-sector paediatric HIV clinic in
Harare, Zimbabwe. A standardized examination including transthoracic echocardiography
was performed. Local echocardiographic reference ranges were used to define
cardiac abnormalities. Logistic regression was used to examine the association between
cardiac abnormalities and risk factors.
RESULTS : Of the 201participants recruited, 92 (46%) were girls and median age was
11 (IQR 9–12) years; CD4þ cell count was 727 cells/ml (IQR 473–935) and 154 (78%)
had viral load less than 400 copies/ml. Echocardiographic abnormalities were found in
83 (42%); left ventricular (LV) diastolic dysfunction was the most common abnormality
45 (23%) and LV hypertrophy in 22 (11%). LV and left atrial dilatation were found in 9
(5%) and 16 (8%), respectively. Right ventricular dilatation and systolic dysfunction
were found in 13 (7%) and 4 (2%), respectively, of whom 60% had concurrent left heart
abnormalities. Current use of nevirapine was associated with LVH [aOR 3.14 (1.13–
8.72; P¼0.03)] and hypertension was associated with LV diastolic dysfunction [aOR
3.12 (1.48–6.57; P<0.01)].
CONCLUSION : HIV-infected children established on ART have a high burden of echocardiographic
abnormalities. Right heart disease was predominantly associated with left heart abnormalities and may be part of a global cardiomyopathic process. Further
studies are needed to investigate the natural history, aetiology, and pathogenesis of
these abnormalities, so that appropriate monitoring and treatment strategies can be
developed.
