Dilation of the aortic root in children infected with human immunodeficiency virus type 1: The Prospective P2C2 HIV Multicenter Study

• Type of Material: Article
• Authors: Wyman W. Lai, Mount Sinai School of Medicine; Steven D. Colan, Harvard University; Kirk Easley, Emory University; Steven E. Lipshultz, University of Rochester; Thomas J. Starc, Columbia University; Timothy Bricker, Baylor College; Samuel Kaplan, University of California Los Angeles
• Language: English
• Date: 2001-04-02
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2001 by Mosby, Inc
• Final Published Version (URL): http://ac.els-cdn.com/S0002870301325334/1-s2.0-S0002870301325334-main.pdf?_tid=14ccecf2-bd67-11e6-b5f4-00000aacb35d&acdnat=1481216291_7c92efc1504f60118f0cdbd781e445db
• Title of Journal or Parent Work: American Heart Journal
• ISSN: 0002-8703
• Volume: 141
• Issue: 4
• Start Page: 661
• End Page: 670
• Grant/Funding Information: This work was 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-00188, RR-00533, RR-00071, RR-00645, RR-00865, and RR-00043).
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background Vascular lesions have become more evident in human immunodeficiency virus type 1 (HIV)-infected patients as the result of earlier diagnosis, improved treatment, and longer survival. Aortic root dilation in HIV-infected children has not previously been described. This study was undertaken to determine the prevalence of aortic root dilation in HIV-infected children and to evaluate some of the potential pathogenic mechanisms. Methods Aortic root measurements were incorporated into the routine echocardiographic surveillance of 280 children of HIV-infected women: an older cohort of 86 HIV-infected children and a neonatal cohort of 50 HIV-infected and 144 HIV-uninfected children. Results By repeated-measures analyses, mean aortic root measurements were significantly increased in HIV-infected children versus HIV-uninfected children (P values of ≤.04 and ≤.005 at 2 and 5 years of age, respectively, for aortic annulus diameter, sinuses of Valsalva, and sinotubular junction). Heart rate, systolic blood pressure, stroke volume, hemoglobin, and hematocrit were not significantly associated with aortic root size. Left ventricular dilation, increased serum HIV RNA levels, and lower CD4 cell count measurements were associated with aortic root dilation at baseline. Conclusions Mild and nonprogressive aortic root dilation was seen in children with vertically transmitted HIV infection from 2 to 9 years of age. Aortic root size was not significantly associated with markers for stress-modulated growth; however, aortic root dilation was associated with left ventricular dilation, increased viral load, and lower CD4 cell count in HIV-infected children. As prolonged survival of HIV-infected patients becomes more prevalent, some patients may require long-term follow-up of aortic root size.