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(Circulation. 2000;102:1542.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Cardiac Dysfunction and Mortality in HIV-Infected Children

The Prospective P²C² HIV Multicenter Study

Steven E. Lipshultz, MD; Kirk A. Easley, MS; E. John Orav, PhD; Samuel Kaplan, MD; Thomas J. Starc, MD, MPH; J. Timothy Bricker, MD; Wyman W. Lai, MD, MPH; Douglas S. Moodie, MD; George Sopko, MD, MPH; Steven D. Colan, MD; for the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection (P²C² HIV) Study Group

From the Division of Pediatric Cardiology (S.E.L.), University of Rochester Medical Center and Children’s Hospital at Strong and Department of Pediatrics (S.E.L.), University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Cardiology (S.E.L., S.D.C.), Children’s Hospital, Department of Pediatrics, Harvard Medical School (S.E.L., S.D.C.), Department of Pediatrics, Boston Medical Center and Boston University School of Medicine (S.E.L.), and Department of Medicine, Brigham and Woman’s Hospital (E.J.O.), Boston, Mass; Department of Biostatistics and Epidemiology (K.A.E.) and Department of Pediatrics, Division of Pediatric Cardiology (D.S.M.), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Pediatrics, Division of Pediatric Cardiology, University of California, Los Angeles Medical Center and School of Medicine, Los Angeles (S.K.); Department of Pediatrics, Division of Pediatric Cardiology, Mt Sinai School of Medicine (W.W.L.), and Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University College of Physicians and Surgeons (T.J.S.), New York, NY; Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex (J.T.B.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.).

Correspondence to Dr Steven E. Lipshultz, Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 631, Rochester, NY 14642. E-mail steve_lipshultz{at}urmc.rochester.edu

Background—Left ventricular (LV) dysfunction is common in children infected with the human immunodeficiency virus (HIV), but its clinical importance is unclear. Our objective was to determine whether abnormalities of LV structure and function independently predict all-cause mortality in HIV-infected children.

Methods and Results—Baseline echocardiograms were obtained on 193 children with vertically transmitted HIV infection (median age, 2.1 years). Children were followed up for a median of 5 years. Cox regression was used to identify measures of LV structure and function predictive of mortality after adjustment for other important demographic and baseline clinical risk factors. The time course of cardiac variables before mortality was also examined. The 5-year cumulative survival was 64%. Mortality was higher in children who, at baseline, had depressed LV fractional shortening (FS) or contractility; increased LV dimension, thickness, mass, or wall stress; or increased heart rate or blood pressure (P0.02 for each). Decreased LV FS (P<0.001) and increased wall thickness (P=0.004) were also predictive of increased mortality after adjustment for CD4 count (P<0.001), clinical center (P<0.001), and encephalopathy (P<0.001). FS showed abnormalities for up to 3 years before death, whereas wall thickness identified a population at risk only 18 to 24 months before death.

Conclusions—Depressed LV FS and increased wall thickness are risk factors for mortality in HIV-infected children independent of depressed CD4 cell count and neurological disease. FS may be useful as a long-term predictor and wall thickness as a short-term predictor of mortality.

Key Words: viruses • mortality • pediatrics • AIDS

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