MedPage Today (04.22.13)
Before the use of today’s antiretroviral therapy (ART), children with HIV infection were more likely to have abnormalities in the left ventricular structure and function that increased their risk of death. Highly Active Antiretroviral therapy (HAART) appears to preserve cardiac function, but the interactions between HIV, ART, and cardiac function is unclear. Steven Lipshultz, MD of the University of Miami and colleagues investigated the effect of long-term HAART on cardiac function. The researchers compared three cohorts—two from the Adolescent Master Protocol of the Pediatrics HIV/AIDS Cohort Study (PHACS) and one from the Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection Study.
The PHACS study was conducted at 14 pediatric HIV clinics in the United States from March 2007 to November 2009 with children aged 7 to 16 years. The researchers reviewed data from 325 children in the PHACS study with perinatal HIV infection who were receiving HAART, which means treatment with at least three ART drugs from at least two ART drug classes and 189 children who were exposed to HIV, but were not infected. Also, researchers reviewed data from the Pulmonary and Cardiovascular Complications (PCHIV) study, which was conducted from 1990 to 1997. They examined data from 70 children from the PCHIV study who were infected with HIV, but were not treated with HAART. All children received echocardiograms.
Compared with HIV-infected youth treated when HAART was not widely used, those mostly treated with HAART had significantly better echocardiographic measures of heart structure and function. Some of the patients from the earlier cohort (PCHIV study), but none of the newer cohort (PHACS study) developed clinical heart disease. The authors concluded that findings suggest an overall cardio protective effect of long-term HAART, but the reasons for this effect are not clear.
The full report, “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,” was published online in the journal JAMA Pediatrics (doi:10.1001/jamapediatrics.2013.1206).