title: 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.
abstract: OBJECTIVE
  Prior to contemporary antiretroviral therapies (ARTs), children infected with human immunodeficiency virus (HIV) were more likely to have heart failure. This study suggests that highly active ART (HAART) does not appear to impair heart function.
  
  
  OBJECTIVE
  To determine the cardiac effects of prolonged exposure to HAART on HIV-infected children.
  
  
  METHODS
  In the National Institutes of Health-funded Pediatric HIV/AIDS Cohort Study's Adolescent Master Protocol (AMP), we used linear regression models to compare echocardiographic measures.
  
  
  METHODS
  A total of 14 US pediatric HIV clinics.
  
  
  METHODS
  Perinatally HIV-infected children receiving HAART (n = 325), HIV-exposed but uninfected children (n = 189), and HIV-infected (mostly HAART-unexposed) historical pediatric controls from the National Institutes of Health-funded Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2-HIV) Study (n = 70). EXPOSURE Long-term HAART.
  
  
  METHODS
  Echocardiographic measures of left ventricular (LV) function and structure.
  
  
  RESULTS
  The 325 AMP HIV-infected children had lower viral loads, higher CD4 counts, and longer durations of ART than did the 70 HIV-infected children from the P2C2-HIV Study (all P < .001). The z scores for LV fractional shortening (a measure of cardiac function) were significantly lower among HIV-infected children from the P2C2-HIV Study than among the AMP HIV-infected group or the 189 AMP HIV-exposed but uninfected controls (P < .05). For HIV-infected children, a lower nadir CD4 percentage and a higher current viral load were associated with significantly lower cardiac function (LV contractility and LV fractional shortening z scores; all P = .001) and an increased LV end-systolic dimension z score (all P < .03). In an interaction analysis by HIV-infected cohort, the HIV-infected children from the P2C2-HIV Study with a longer ART exposure or a lower nadir CD4 percentage had lower mean LV fractional shortening z scores, whereas the mean z scores were relatively constant among AMP HIV-infected children (P < .05 for all interactions).
  
  
  CONCLUSIONS
  Long-term HAART appears to be cardioprotective for HIV-infected children and adolescents.
authors.affiliation: Department of Pediatrics, Universityof Miami Leonard M. Miller School of Medicine, FL, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: James D
authors.initials: JD
authors.lastname: Wilkinson
authors.forename: Erin C
authors.initials: EC
authors.lastname: Leister
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: William T
authors.initials: WT
authors.lastname: Shearer
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Rich
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
authors.forename: Denise L
authors.initials: DL
authors.lastname: Jacobson
authors.forename: Laurie B
authors.initials: LB
authors.lastname: Dooley
authors.forename: Gwendolyn B
authors.initials: GB
authors.lastname: Scott
authors.forename: Nicole
authors.initials: N
authors.lastname: Rabideau
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*