title: Resolution of dilated cardiomyopathy in an adolescent with change of a failing highly active antiretroviral drug therapy.
abstract: BACKGROUND
  Cardiovascular dysfunction is a recognized complication of HIV infection in children. Cardiac complications of HIV usually occur late in the course of the disease; they may be associated with drug therapy, and hence become more common as therapy and survival improve. Left ventricular (LV) dysfunction at baseline is a risk factor for death independent of the CD4 cell count, HIV viral load, and neurological disease.
  
  
  METHODS
  We present the case of a 15 year old girl with HIV who developed left ventricular dysfunction while non-compliant on highly active antiretroviral therapy (HAART). She presented with features of heart failure over a course of two months. Her laboratory evaluation was significant for leucopenia with a low CD4 count, high viral load, elevated ESR and CRP. The ECG showed a sinus tachycardia with diffuse ST-T segment changes and LVH with strain. Initial echo revealed dilated left heart chambers with poor LV systolic function and a small pericardial effusion with the development of an LV thrombus on follow up echo evaluation. She was started on heart failure medicines and had anticoagulation for the LV thrombus. She received adherence counseling and her HAART regimen was changed. Six months after presentation she became asymptomatic with higher CD4 counts and a normal LV size and function on echo.
  
  
  CONCLUSIONS
  Immunological recovery following a switch of a failing or potentially cardiotoxic HAART in addition to improved HAART adherence may result in resolution of left ventricular dysfunction. Early and regular cardiology evaluation may improve outcomes in these patients.
authors.affiliation: Department of Paediatrics and Child Health, Gulu University ; Uganda Heart Institute, Mulago Hospital Complex.
authors.forename: Twalib Olega
authors.initials: TO
authors.lastname: Aliku
authors.affiliation: Uganda Heart Institute, Mulago Hospital Complex.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Lubega
authors.affiliation: Uganda Heart Institute, Mulago Hospital Complex.
authors.forename: Peter
authors.initials: P
authors.lastname: Lwabi
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D006332:Cardiomegaly / Q000000981:diagnostic imaging*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D003376:Counseling; D004562:Electrocardiography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D055118:Medication Adherence; D011859:Radiography; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology; D016277:Ventricular Function, Left / Q000187:drug effects*; D019562:Viral Load
chemical_list: D000925:Anticoagulants
keywords: Dilated Cardiomyopathy; HAART
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