PEDIATRICS Vol. 112 No. 2 August 2003, pp. 491
INCIDENCE OF CARDIAC ABNORMALITIES IN CHILDREN WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION: THE PROSPECTIVE P2C2 HIV STUDY
Joseph A. Church, MD
Los Angeles, CA
Starc TJ, Lipshultz SE, Easley KA, et al. J Pediatr. 2002;141:327–334
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Purpose of the Study.
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Human immunodeficiency virus (HIV) infection may be associated
with severe cardiac complications. The objective of this study
was to describe the 5-year cumulative incidence of cardiac abnormalities
in HIV-infected children.
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Methods.
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A prospective cohort was developed involving children from 10
hospitals throughout the United States. Group I included 205
HIV-infected children enrolled at a median age of 1.9 years
and group II consisted of 600 HIV-exposed children enrolled
prenatally or as neonates. Of this group, 93 were ultimately
shown to be HIV-infected. Echocardiographic indices of left
ventricular function were measured every 4 to 6 months.
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Results.
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In group I (retrospectively identified HIV-infected children),
the 5-year incidence of left ventricular fractional shortening
of
25% was 28%; left ventricular end-diastolic dilatation was
21.7%; and heart failure or the use of cardiac medications was
28.8%. The mortality rate 1 year after the diagnosis of heart
failure was >50%. Within group II (at-risk infants), the
5-year incidence of decreased fractional shortening was 10.7%
in the HIV-infected compared with 3.1% in the HIV-uninfected
children. Left ventricular dilation, heart failure, or the use
of cardiac medications were more common in infected children.
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Conclusions.
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During the 5 years of this study, cardiac dysfunction occurred
in up to 39% of HIV-infected children and was associated with
an increased risk of death. The authors recommended that HIV-infected
children undergo routine echocardiographic surveillance for
cardiac abnormalities.
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Reviewer’s Comments.
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Prospective natural history studies are particularly useful
as a tool to understand disease progression. The Pediatric Pulmonary
and Cardiovascular Complications of Vertically Transmitted HIV
Infection Study (P
2C
2) was initiated in 1990 and enrollment
was concluded in 1994. At that time, very limited antiretroviral
therapies were available and there were no potent combination
therapies, currently referred to as highly active antiretroviral
therapy (HAART). The remarkably high incidence of cardiac disease
in this patient population largely represents the natural history
of untreated or marginally treated HIV in perinatally infected
children. The current incidence of heart disease in HIV-infected
children is likely to be much less, and patients with previously
demonstrated profound cardiac compromise have been noted to
have normalized their echocardiographic measurements. It is
not clear that routine echocardiographics surveillance of all
HIV-infected children is indicated currently. In the HAART era,
the best strategy for heart monitoring requires additional investigation.
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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Purpose of the Study.
Methods.
