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J Am Coll Cardiol. 2017 Oct 31;70(18):2240-2247. doi: 10.1016/j.jacc.2017.09.008.

Cardiac Effects of Highly Active Antiretroviral Therapy in Perinatally HIV-Infected Children: The CHAART-2 Study.

Author information

1
Wayne State University School of Medicine, Detroit, Michigan; Children's Hospital of Michigan, Detroit, Michigan. Electronic address: slipshultz@med.wayne.edu.
2
Wayne State University School of Medicine, Detroit, Michigan.
3
Theta Hat Statistical Consultants, Owings Mills, Maryland.
4
Ohio State University Medical Center and Nationwide Children's Hospital, Columbus, Ohio.
5
Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
6
Brigham and Women's Hospital, Boston, Massachusetts.
7
University of Miami Miller School of Medicine, Miami, Florida.
8
Boston Children's Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Before the introduction of highly active antiretroviral therapy (HAART), cardiac mortality and morbidity were common in HIV-infected children.

OBJECTIVES:

This study sought to identify long-term cardiovascular effects of HAART in HIV-infected children.

METHODS:

The CHAART-2 (HAART-Associated Cardiotoxicity in HIV-Infected Children) study prospectively compared 148 echocardiograms from 74 HAART-exposed children to 860 echocardiograms from 140 HAART-unexposed but HIV-infected children from the Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection (P2C2 HIV) study. Both studies used similar protocol, centralized echocardiographic interpretation, and measures expressed as z-scores referenced to healthy controls. Associations between HAART exposure and echocardiographic measures were evaluated using generalized estimating equations.

RESULTS:

Comparing the HAART-exposed and HAART-unexposed groups, any HAART exposure was positively associated with left ventricular (LV) fractional shortening (z-score for difference = 1.07; p = 0.02) and HAART exposure duration (z-score difference per year = 0.17; p = 0.003. LV mass was negatively associated with any HAART exposure (z-score difference = -0.64; p = 0.01) as was septal thickness (z-score difference = -0.93; p = 0.001). Duration of HAART exposure was negatively associated with LV end-systolic dimension and heart rate (z-score difference per year= -0.11; p = 0.05; and z-score difference per year = -0.10; p = 0.002, respectively). During 11 years of follow-up, in the HAART-exposed group, LV mass and LV end-diastolic septal thickness were lower whereas LV contractility and LV fractional shortening were higher when compared to the HAART-unexposed group.

CONCLUSIONS:

Cardiac structure and function were better in perinatally HIV-infected children exposed to HAART than in those of similar children from the pre-HAART era but did decline over time. Evidence-based strategies for cardiovascular monitoring are needed to inform treatment decisions to improve long-term cardiovascular health.

KEYWORDS:

HIV; antiretroviral therapy; cardiomyopathy; pediatric

Comment in

PMID:
29073951
PMCID:
PMC5687306
DOI:
10.1016/j.jacc.2017.09.008
[Indexed for MEDLINE]
Free PMC Article

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