Abstract
BackgroundCardiac involvement in HIV infected children has been frequently reported, but whether this is due to HIV infection itself or to antiretroviral treatment (ART) is unknown.MethodsThis cross sectional study involved 114 vertically-acquired HIV-infected (56 ART-naive, 58 ART-exposed) and 51 healthy children in Jakarta, Indonesia. Echocardiography was performed to measure dimensions of the left ventricle (LV) and systolic functions. We applied general linear modeling to evaluate the associations between HIV infection/treatment status and cardiac parameters with further adjustment for potential confounders or explanatory variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children, with 95% confidence intervals and p values.ResultsCompared to healthy children, ART-naïve HIV-infected children did not show significant differences in age-and-height adjusted cardiac dimensions apart from larger LV internal diameter (difference 2.0 mm, 95%CI 0.2 to 3.7), whereas ART exposed HIV infection showed thicker LV posterior walls (difference = 1.1 mm, 95%CI 0.5 to 1.6), larger LV internal diameter (difference = 1.7 mm, 95%CI 0.2 to 3.2) and higher LV mass (difference = 14.0 g, 7.4 to 20.5). With respect to systolic function, reduced LV ejection fraction was seen in both ART-naïve HIV infected (adjusted difference = -6.7%, -11.4 to -2.0) and, to a lesser extent, in ART-exposed HIV infected children (difference = -4.5%, -8.5 to -0.4). Inflammation level seemed to be involved in most associations in ART-exposed HIV-infected, but few, if any, for decreased function in the ART-naive ones, whereas lower hemoglobin appeared to partially mediate chamber dilation in both groups and reduced function, mainly in ART-exposed children.ConclusionsART-naive HIV infected children have a substantial decrease in cardiac systolic function, whereas the ART-exposed have thicker ventricular walls with larger internal diameter and higher mass, but less functional impairment.
Highlights
Cardiac involvement in HIV infected children has been frequently reported, but whether this is due to HIV infection itself or to antiretroviral treatment (ART) is unknown
ART-naive HIV infected children have a substantial decrease in cardiac systolic function, whereas the ART-exposed have thicker ventricular walls with larger internal diameter and higher mass, but less functional impairment
HIV infection in children remains an important global health challenge, because the incidence is still rising in some parts of the world, [1] and due to its systemic and long term consequences
Summary
This cross sectional study involved 114 vertically-acquired HIV-infected (56 ART-naive, 58 ART-exposed) and 51 healthy children in Jakarta, Indonesia. We performed a cross-sectional analysis on 114 HIV infected and 51 healthy children enrolled in an ongoing cohort established in June 2013 in Jakarta, Indonesia. HIV infected children (56 ART-naïve and 58 ART-exposed) were recruited from the pediatric HIV clinics of Cipto Mangunkusumo National General Hospital, Koja District Hospital, and the Indonesian Planned Parenthood Association (IPPA), Jakarta Indonesia. We excluded children with conditions suggestive of non-vertically acquired HIV (HIV-negative parents and previous blood transfusion). Healthy children with the same age range were invited for this research, from the area around the Cipto Mangunkusumo hospital by directly approaching parents and community leaders and providing leaflets explaining the purpose and procedures of the study. Of the total of 55 children invited, 3 declined to participate because parents/guardians were not able to accompany the child to the hospital or refusal to blood sampling and 1 was excluded due to dysmorphic features suggestive of a syndrome
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