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High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy

Majonga, ED; Rehman, AM; Simms, V; Mchugh, G; Mujuru, HA; Nathoo, K; Odland, JO; ... Ferrand, RA; + view all (2018) High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy. AIDS , 32 (18) pp. 2739-2748. 10.1097/QAD.0000000000002031. Green open access

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Abstract

BACKGROUND: Antiretroviral therapy (ART) has decreased mortality so that increasing numbers of children with HIV are reaching adolescence. However, longstanding HIV infection and/or its treatment in children is associated with non-infectious complications including cardiac disease. We investigated the prevalence, spectrum and risk factors for echocardiographic abnormalities among children established on ART. METHODS: HIV-infected children aged 6-16 years, on ART ≥6 months were enrolled into a cross-sectional study from a public-sector paediatric HIV clinic in Harare, Zimbabwe. A standardised examination including transthoracic echocardiography was performed. Local echocardiographic reference ranges were used to define cardiac abnormalities. Logistic regression was used to examine the association between cardiac abnormalities and risk factors. RESULTS: Of the 201participants recruited, 92 (46%) were female and median age was 11 (IQR 9-12) years; CD4 count was 727 cells/μl (IQR 473-935) and 154 (78%) had viral load <400 copies/ml. Echocardiographic abnormalities were found in 83 (42%); left ventricular (LV) diastolic dysfunction was the most common abnormality 45 (23%) and LV hypertrophy in 22 (11%). LV and left atrial dilatation were found in 9 (5%) and 16 (8%), respectively. Right ventricular dilatation and systolic dysfunction were found in 13 (7%) and 4 (2%) respectively, of whom 60% had concurrent left heart abnormalities. Current use of nevirapine was associated with LVH [aOR 3.14 (1.13-8.72; p = 0.03)] and hypertension was associated with LV diastolic dysfunction [aOR 3.12 (1.48-6.57; p < 0.01)]. CONCLUSIONS: HIV-infected children established on ART have a high burden of echocardiographic abnormalities. Right heart disease was predominantly associated with left heart abnormalities and may be part of a global cardiomyopathic process. Further studies are needed to investigate the natural history, aetiology and pathogenesis of these abnormalities so that appropriate monitoring and treatment strategies can be developed.

Type: Article
Title: High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000002031
Publisher version: https://doi.org/10.1097/QAD.0000000000002031
Language: English
Additional information: © 2019 Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (http://creativecommons.org/licenses/by/4.0).
Keywords: cardiac abnormalities, HIV, children, ART, Africa
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
URI: https://discovery.ucl.ac.uk/id/eprint/10059256
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