Cardiac Changes Linked With Specific ARVs in Perinatally Acquired HIV

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Cardiac function was significantly better in the 69% of individuals on combination regimens that included a protease inhibitor.
Cardiac function was significantly better in the 69% of individuals on combination regimens that included a protease inhibitor.

Individual antiretroviral medications have been linked with changes in cardiac structure in youths with perinatally acquired HIV, according to a study recently published in AIDS. Although combinations of antiretroviral medications have demonstrated a tendency to protect the heart, the toxicity profiles of drugs such as zidovudine merit replacement with more favorable options.

This multisite, prospective study included 325 youth aged 7 to 16 years with perinatally acquired HIV. These individuals were given an echocardiogram in order to investigate cardiac structure and function.

Cardiac function was significantly better in the 69% of individuals on combination regimens that included a protease inhibitor. Adjustments for additional antiretrovirals and controlling for false discovery rate revealed no individual medication with a significant link to left ventricular function. However, end-systolic wall stress was higher in adjusted mean Z-scores among those using zidovudine.

Additionally, zidovudine use correlated with increased scores on wall stress and heart size. Nevirapine also correlated with increased scores for heart size, while lopinavir was linked with more favorable scores for heart function. Wall stress, heart size, and function of the heart were discovered via factor analysis to be 3 latent factors.

This study investigated the links between the Z-scores for 11 metrics of left ventricular structure/function and 18 types of antiretroviral medications. Adjusted linear regression models were used to examine all antiretroviral medications, whereas hierarchical models were applied to approximate the effects of individuals' medication variations from drug class means. Results were taken from research at 14 hospitals located in the United States and Puerto Rico.

The study researchers "observed beneficial effects of cART regimens which included protease inhibitors on cardiac outcomes in youth with PHIV. However, given the large number of options for specific ARV drugs that can be included in combination regimens, some ARVs such as zidovudine could be replaced by those with more favorable toxicity profiles”.

Reference

Williams PL, Correia K, Karalius B, et al. Cardiac status of perinatally HIV-infected children: assessing combination antiretroviral regimens in observational studies [published online August 9, 2018]. AIDS. doi: 10.1097/QAD.0000000000001988

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