Cardiac Effects of Antiretroviral-Naïve versus Antiretroviral-Exposed HIV Infection in ChildrenReport as inadecuate




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Background

Cardiac involvement in HIV infected children has been frequently reported, but whether this is due to HIV infection itself or to antiretroviral treatment ART is unknown.

Methods

This cross sectional study involved 114 vertically-acquired HIV-infected 56 ART-naive, 58 ART-exposed and 51 healthy children in Jakarta, Indonesia. Echocardiography was performed to measure dimensions of the left ventricle LV and systolic functions. We applied general linear modeling to evaluate the associations between HIV infection-treatment status and cardiac parameters with further adjustment for potential confounders or explanatory variables. Findings are presented as adjusted mean differences between each of the two HIV groups and healthy children, with 95% confidence intervals and p values.

Results

Compared to healthy children, ART-naïve HIV-infected children did not show significant differences in age-and-height adjusted cardiac dimensions apart from larger LV internal diameter difference 2.0 mm, 95%CI 0.2 to 3.7, whereas ART exposed HIV infection showed thicker LV posterior walls difference = 1.1 mm, 95%CI 0.5 to 1.6, larger LV internal diameter difference = 1.7 mm, 95%CI 0.2 to 3.2 and higher LV mass difference = 14.0 g, 7.4 to 20.5. With respect to systolic function, reduced LV ejection fraction was seen in both ART-naïve HIV infected adjusted difference = -6.7% -11.4 to -2.0 and, to a lesser extent, in ART-exposed HIV infected children difference = -4.5% -8.5 to -0.4. Inflammation level seemed to be involved in most associations in ART-exposed HIV-infected, but few, if any, for decreased function in the ART-naive ones, whereas lower hemoglobin appeared to partially mediate chamber dilation in both groups and reduced function, mainly in ART-exposed children.

Conclusions

ART-naive HIV infected children have a substantial decrease in cardiac systolic function, whereas the ART-exposed have thicker ventricular walls with larger internal diameter and higher mass, but less functional impairment.



Author: Nikmah S. Idris , Michael M. H. Cheung , Diederick E. Grobbee , David Burgner , Nia Kurniati, Cuno S. P. M. Uiterwaal

Source: http://plos.srce.hr/



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