Abstract 4037: Increased Left Ventricular and Aortic Dimensions in Long-Term Multiagent Antiretroviral Therapy (ART)-Treated HIV-Infected Children: The NIH Multicenter Pediatric HIV/AIDS Cohort Study (PHACS)
Background: Dilated cardiomyopathy, heart failure, aortic dilation, and cardiac death occurred more frequently in HIV+ children prior to the use of highly active antiretroviral therapy (HAART). Limited data exist on cardiovascular status of HIV+ children in the HAART era.
Methods: Cardiovascular status was prospectively evaluated with centrally-read echos in HIV+ and HIV-control children in the NIH PHACS Adolescent Master Protocol (AMP). Z-scores were based on an HIV- reference group, and compared between AMP HIV+ and HIV- controls by linear regression models.
Results: 109 HIV+ and 45 HIV- subjects in the AMP study, aged 7–16 yrs, had echos performed. HIV+ subjects were highly ART-experienced, with 86% on HAART for >5 years, and a mean HAART duration of 8.1 yrs (SD 2.9). At the time of echo, 94% were on HAART (78% on protease inhibitors, 95% on NRTIs, and 27% on NNRTIs). Most HIV+ were asymptomatic; 23% had CDC symptomatic Class C, the median CD4 count was 722 cells/mm3, and 70% had HIV RNA viral load <400 copies/mL. Linear regression analyses showed significantly larger left ventricular (LV) and aortic valve (AV) dimensions and reduced LV function in HIV+ compared to HIV- patients; specifically for LV end-systolic dimension (mean Z-scores 0.242 vs −0.527, p=0.07, n=149); LV ejection fraction (means −0.110 vs 0.260, p=0.04, n=148); AV annulus area (means 0.446 vs −0.224, p=0.001, n=132); and AV annulus diameter (means 0.367 vs −0.290, p=0.001, n=132). Extreme Z-scores either >2 for LV dimension, AV area or diameter, or <-2 for LVEF were present in 11/109 (10%) of HIV+ and in 0/45 of HIV- subjects (p=0.03). Among HIV+ patients, there were no significant differences in cardiac Z-scores between those with CDC Class C vs less symptomatic classes; however, the AV annulus area increased significantly for each 1 unit increase in log HIV-RNA viral load (Z-score change=0.113, p=0.03, n=93).
Conclusions: Alterations in LV size and function and aortic valve dimension are present in long-term HAART-treated HIV+ children relative to HIV-controls, suggesting possible subclinical cardiovascular disease. The role of HIV disease severity requires further exploration. HIV+ children exposed to HAART should have their cardiac status monitored in longitudinal research studies.