Abstract 16026: Association of Cardiac Structure and Function with In Utero Antiretroviral Exposure Among Uninfected Children Born to HIV-Infected Mothers in the Pediatric HIV/AIDS Cohort Study
Introduction: Use of prenatal antiretroviral therapy (ART) in the U.S. has resulted in < 2% maternal-to-child HIV transmission. However, the long term non-HIV health effects of in utero ART exposure for these children is a concern, including potential adverse effects on the heart. Hypothesis: In a cohort of HIV-uninfected children, in utero exposure to ART will be associated with effects on cardiac parameters.
Methods: Echocardiograms (echos) were performed in HIV-uninfected (HIV-) children born to HIV-infected mothers in the PHACS SMARTT Protocol. Echo parameters were expressed as Z-scores referenced to a normal pediatric population. Using linear regression models, echo Z-scores were compared between HIV- children exposed to highly active ART (HAART) in the 1st trimester to those unexposed to 1st trimester HAART, and compared for in utero exposure to specific ART drugs.
Results: We studied 231 HIV- children with echos performed at 3-5 years of age (mean = 4.3 years); 73% were non-White, and 50% female. Neither maternal drug use (10% illicit drugs, 7% alcohol, 18% tobacco) nor maternal HIV health status (CD4 count, viral load) during pregnancy was significantly associated with echo Z-scores. Overall, 84% had echo Z-scores within normal range (-2 to +2). Significant differences were observed in certain echo Z-scores for those with vs without 1st trimester HAART exposure: higher LV wall thickness (adjusted mean difference (Δ)=0.22, P=0.06), lower end-diastolic LV dimension (Δ=-0.33, P=0.01), higher mean thickness-to-dimension ratio (Δ=0.31, P=0.003), and decreased aortic valve (AV) diameter Z-scores (Δ=-0.24, P=0.05). Those exposed to abacavir had lower mean end-systolic LV dimension Z-scores (Δ=-0.26, P= 0.04), while those exposed to nevirapine had higher LV wall thickness ( Δ=0.34, P= 0.02). Those exposed to nelfinavir had significantly lower AV diameter (Δ-0.38, P= 0.003). No significant differences in measures of LV function were observed.
Conclusions: HIV-uninfected children exposed to HAART early in pregnancy have significant differences in cardiac structural parameters compared to those not exposed to HAART in the 1st trimester. Longer term cardiac follow-up is needed to determine the clinical significance of these findings.
- © 2010 by American Heart Association, Inc.