Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2C2 HIV study.
OBJECTIVE
To describe the 5-year cumulative incidence of cardiac dysfunction in human immunodeficiency virus (HIV)-infected children.


METHODS
We used a prospective cohort design, enrolling children at 10 hospitals. Group I included 205 vertically HIV-infected children enrolled at a median age of 1.9 years. Group II consisted of 600 HIV-exposed children enrolled prenatally or as neonates, of whom 93 were ultimately HIV-infected. The main outcome measures were echocardiographic indexes of left ventricular dysfunction.


RESULTS
In group I, the 5-year cumulative incidence of left ventricular fractional shortening </=25% was 28.0%. The 5-year incidence of left ventricular end-diastolic dilatation was 21.7%, and heart failure and/or the use of cardiac medications 28.8%. The mortality rate 1 year after the diagnosis of heart failure was 52.5% [95% CI, 30.5-74.5]. Within group II, the 5-year cumulative incidence of decreased fractional shortening was 10.7% in the HIV-infected compared with 3.1% in the HIV-uninfected children (P =.01). Left ventricular dilation, heart failure, and/or the use of cardiac medications were more common in infected compared with uninfected children.


CONCLUSIONS
During 5 years of follow-up, cardiac dysfunction occurred in 18% to 39% of HIV-infected children and was associated with an increased risk of death. We recommend that HIV-infected children undergo routine echocardiographic surveillance for cardiac abnormalities.
Starc
Thomas J
TJ
Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University, College of Physicians and Surgeons, New York City, New York, USA.
Lipshultz
Steven E
SE
Easley
Kirk A
KA
Kaplan
Samuel
S
Bricker
J Timothy
JT
Colan
Steven D
SD
Lai
Wyman W
WW
Gersony
Welton M
WM
Sopko
George
G
Moodie
Douglas S
DS
Schluchter
Mark D
MD
D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000635:transmission; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D015993:Life Tables; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000821:virology