Abstract:
BACKGROUND : Right heart abnormalities and pulmonary hypertension (PH) may be secondary to chronic lung
disease. Chronic lung disease is common in children with HIV. In the BREATHE trial (Trial registration:
NCT02426112), azithromycin (AZM) reduced the risk of acute respiratory exacerbations in children aged 6–19
years with HIV-associated chronic lung disease (HCLD) taking antiretroviral therapy. We assessed the possible
effect of AZM on right heart dysfunction and/or PH in the trial.
METHODS : A standardised transthoracic echocardiogram using M-mode, two-dimensional and Doppler was performed,
at baseline and at completion of weight-based AZM given weekly for 48 weeks. Linear regression was
used to compare trial arms.
RESULTS : A total of 169 participants (82 AZM arm; 87 placebo arm) were included. Participants in the placebo arm
were older, median age 16.2 (13.0–18.2) vs 15.3 (12.9–17.4) years, p = 0.184 in the AZM arm. At baseline, right
heart abnormalities (right ventricular systolic dysfunction (RVSD), dilatation, or PH) were observed in 7(4%).
Following treatment, there was no difference in prevalence of RVSD between arms (p = 0.761). There was one
incident case of suspected PH, and overall, no difference in pulmonary pressures.
CONCLUSION : In children with HCLD, there was evidence of secondary cardiac effects, but AZM had no effect on
right heart function. Long-term follow-up in children with HIV should be part of future research to understand
the clinical implications of right heart abnormalities.
