0
Article |

Cardiac Status of Children Infected With Human Immunodeficiency Virus Who Are Receiving Long-term Combination Antiretroviral Therapy:  Results From the Adolescent Master Protocol of the Multicenter Pediatric HIV/AIDS Cohort Study

Steven E. Lipshultz, MD; Paige L. Williams, PhD; James D. Wilkinson, MD, MPH; Erin C. Leister, MS; Russell B. Van Dyke, MD; William T. Shearer, MD, PhD; Kenneth C. Rich, MD; Rohan Hazra, MD; Jonathan R. Kaltman, MD; Denise L. Jacobson, PhD; Laurie B. Dooley, MT, MBA; Gwendolyn B. Scott, MD; Nicole Rabideau, RDCS; Steven D. Colan, MD; for the Pediatric HIV/AIDS Cohort Study (PHACS)
JAMA Pediatr. 2013;167(6):520-527. doi:10.1001/jamapediatrics.2013.1206.
Text Size: A A A
Published online

Importance Prior to contemporary antiretroviral therapies (ARTs), children infected with human immunodeficiency virus (HIV) were more likely to have heart failure. This study suggests that highly active ART (HAART) does not appear to impair heart function.

Objective To determine the cardiac effects of prolonged exposure to HAART on HIV-infected children.

Design In the National Institutes of Health–funded Pediatric HIV/AIDS Cohort Study's Adolescent Master Protocol (AMP), we used linear regression models to compare echocardiographic measures.

Setting A total of 14 US pediatric HIV clinics.

Participants Perinatally HIV-infected children receiving HAART (n = 325), HIV-exposed but uninfected children (n = 189), and HIV-infected (mostly HAART-unexposed) historical pediatric controls from the National Institutes of Health–funded Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2-HIV) Study (n = 70).

Exposure Long-term HAART.

Main Outcomes and Measures Echocardiographic measures of left ventricular (LV) function and structure.

Results The 325 AMP HIV-infected children had lower viral loads, higher CD4 counts, and longer durations of ART than did the 70 HIV-infected children from the P2C2-HIV Study (all P < .001). The z scores for LV fractional shortening (a measure of cardiac function) were significantly lower among HIV-infected children from the P2C2-HIV Study than among the AMP HIV-infected group or the 189 AMP HIV-exposed but uninfected controls (P < .05). For HIV-infected children, a lower nadir CD4 percentage and a higher current viral load were associated with significantly lower cardiac function (LV contractility and LV fractional shortening z scores; all P = .001) and an increased LV end-systolic dimension z score (all P < .03). In an interaction analysis by HIV-infected cohort, the HIV-infected children from the P2C2-HIV Study with a longer ART exposure or a lower nadir CD4 percentage had lower mean LV fractional shortening z scores, whereas the mean z scores were relatively constant among AMP HIV-infected children (P < .05 for all interactions).

Conclusions and Relevance Long-term HAART appears to be cardioprotective for HIV-infected children and adolescents.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Association between certain echocardiographic parameters and nadir CD4 percentage. For children infected with human immunodeficiency virus (HIV), the level of exposure to antiretroviral therapy (ART) is an effect modifier on the association between the nadir CD4 percentage and the left ventricular (LV) fractional shortening z score (P = .001 for interaction) (A) and between the nadir CD4 percentage and the LV end-systolic dimension z score (P = .014 for interaction) (B). Perinatally HIV-infected children in the Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2-HIV) Study were relatively unexposed to ART (1990-1997). Perinatally HIV-infected children in the Adolescent Master Protocol (AMP) were exposed to highly active ART. The solid lines represent separate regression lines for each cohort.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com
brightcove.createExperiences();