Abstract 4038: Antiretroviral Therapy (ART) Cardiac Effects in HIV-Infected Children: The Multicenter NHLBI Cardiac Highly Active Antiretroviral Therapy (CHAART-II) Study
Background: In the pre-highly active ART (HAART)/multi-ART era HIV+ children commonly experienced cardiac morbidity and mortality. The effect of HAART/multi-ART exposure is unknown; exposure may be cardiotoxic or, by improving health, may reduce HIV cardiomyop-athy.
Methods: HAART/multi-ART effects on cardiovascular status were prospectively evaluated by echos on HIV+ children enrolled on the NHLBI CHAART-II study. CHAART II children’s echos were compared to those of unexposed (or received only mono-ART) HIV+ children from the NHLBI P2C2-HIV study. Both studies used a common protocol, central reading and Z-scores referenced to healthy controls. The exposure echo effect was evaluated by GEE models accounting for age, ethnicity, and gender.
Results: 860 echos from 140 unexposed children were compared to 148 echos from 74 exposed HIV+ children aged 40 –200 mos. Cardiac outcomes by multi-ARTexposure are shown in the table⇓. For LV mass, ED septal wall thickness, ES afterload, and ED dimension, the exposed group values were consistently lower. For LV contractility and fractional shortening, the exposed group measurements became higher than the unexposed over time. For heart rate and ES dimension, the exposed group measurements became lower than the unexposed over time.
Conclusions: HAART/multi-ART exposure has cardiac effects in HIV+ children including lower septal thickness, LV mass, dimension, and afterload and higher LV fractional shortening and contractility than in HIV+ unexposed children. For some parameters these effects are large and sustained; others (contractility and heart rate) tended to improve with age. With exposure, septal thickness and LV mass fell from above to below healthy controls. Subclinical dilated cardiomyopathy resolved with exposure. The late effects of reduced septal thickness, LV mass and afterload are unknown.