Abstract
Background: HIV infection and lifelong cART are responsible of an increase in cardiovascular risk. The aim of this study was to describe the subclinical cardiovascular disease and to identify early markers of cardiovascular damage in adolescents and young adults vertically infected with HIV on cART, through an innovative multi-parametric approach. Methods: We enrolled 52 patients vertically infected with HIV. Demographic records, traditional cardiovascular risk factors, laboratory findings and echocardiographic measurements were collected in a one-year routine follow up. The echocardiographic examination included measurements of the 2D and 3D ejection fraction (EF), E/A ratio, E/E′ ratio, carotid intima media thickness (cIMT), flow-mediated dilation (FMD) and global longitudinal strain (GLS). Results: At the time of enrolment, all the patients were on cART therapy. The viral load was suppressed in 95% of them. EF was normal in 94.2% of patients (66 ± 7.2%), and GLS (mean value: −20.0 ± 2.5%) was reduced in 29% of patients. The cIMT mean value was higher than the 95th centile for sex and age in 73%, and FMD was impaired in 45% of patients. Clinically evident disease was found in three patients: dilative cardiomyopathy in one, thoracic-abdominal aneurysm Crawford type II with a bilateral carotid dilation in one and carotid plaque with 30% of stenosis in a third patient. Conclusions: This study confirms the presence of clinical and subclinical cardiovascular disease in a very young population vertically infected with HIV, underlining the importance of an early, multi-parametric cardiovascular follow up.
Highlights
The antiretroviral therapies led to an increased survival of patients infected with human immunodeficiency virus (HIV), the population of children and adolescents vertically infected with HIV is at high risk for long-term non-acquired immune-deficiency syndrome-related complications, due both to chronic immune activation and early cellular senescence [1]
Despite the effective viral suppression, patients with vertically transmitted HIV infection are at high risk of early onset of cardiovascular diseases
If clinical disorders are relatively uncommon (5.7%), the 83% of the subjects enrolled in this study presented at least one marker of subclinical cardiovascular disease
Summary
The antiretroviral therapies led to an increased survival of patients infected with human immunodeficiency virus (HIV), the population of children and adolescents vertically infected with HIV is at high risk for long-term non-acquired immune-deficiency syndrome (non-AIDS)-related complications, due both to chronic immune activation and early cellular senescence [1]. These processes lead to a lifelong systemic inflammatory condition, which is a driver for multi-systemic diseases. Other markers of cardiovascular risk in HIV vertically infected patients are carotid intima media thickness (cIMT) and flow-mediated dilation (FMD) [8]. Results: At the time of enrolment, all the patients were on cART therapy
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