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

• Type of Material: Article
• Authors: Thomas J. Starc, Columbia University; Steven E. Lipshultz, Harvard University; Kirk Easley, Emory University; Samuel Kaplan, University of California Los Angeles; J. Timothy Bricker, Baylor College of Medicine; Steven D. Colan, Harvard University; Wyman W. Lai, Mount Sinai School of Medicine; Welton M. Gersony, Columbia University; George Sopko, National Heart, Lung, and Blood Institute; Douglas S. Moodie, Cleveland Clinic Foundation; Mark D. Schluchter, Cleveland Clinic Foundation
• Language: English
• Date: 2002-09-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2002 Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1067/mpd.2002.126301
• Title of Journal or Parent Work: The Journal of Pediatrics
• Volume: 141
• Issue: 3
• Start Page: 327
• End Page: 335
• Grant/Funding Information: 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).
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

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.