Echocardiographic abnormalities in older children and adolescents with HIV also receiving antiretroviral therapy (ART) in Sub-Saharan Africa are likely primary HIV-related heart muscle disease, according to data published in Clinical Infectious Diseases.

A prospective cohort study was conducted to investigate the high prevalence of cardiac abnormalities in Sub-Saharan African children receiving ART. Children aged 6 to 16 years were enrolled at a single clinic, and transthoracic echocardiography was performed at baseline and 18 months.

A total of 175 children completed the study, 48% of which were girls; the median age of the cohort was 12 years (interquartile range, 10-14 years). The incidence of left and right heart abnormalities was 3.52 and 5.64 per 100 person-years, respectively. Growth stunting was associated with the development of any cardiac abnormality (adjusted odds ratio, 2.59 95% CI, 1.03-6.49; P =.043).

Of the 18 patients (10%) with left ventricular hypertrophy at baseline, 15 patients demonstrated the same at follow-up. Left atrial dilatation persisted in 20% of patients from baseline to follow-up. Researchers also noted that though 1% (n=2), and 7% (n=12) of patients demonstrated right ventricular dysfunction and right ventricular dilatation, respectively, at baseline, this number was increased to 11 and 23 participants, respectively, at follow-up. At 18 months, there was also an overall increase in mean z-scores for left ventricular, left atrium, right ventricular, interventricular septum, and left ventricular posterior wall diameters (P <.001).

The investigators noted that the study did not include viral load measures, and was therefore underpowered to detect any associations between incident cardiac disease and viral load. The study also did not include biomarkers, but blood was sampled and stored. Further, the use of advanced echocardiographic techniques would have provided more imaging, but the study authors noted that the results will now be more applicable to other resource-limited settings.

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According to investigators, the lack of associations between the high incidence of cardiac abnormalities with lung and HIV factors in this population suggested they are the result of primary HIV-related disease. They also found some evidence of disease progression during a short follow-up period and recommend that longer follow-up is needed to understand the clinical implications of these abnormalities.

Also, the investigators believe that the results suggested “the potential for progression of cardiac abnormalities and highlight the importance of routine screening for cardiac disease in children with HIV, even in the absence of symptoms.”

Reference

Majonga ED, Rehman AM, Mchugh G, et al. Incidence and progression of echocardiographic abnormalities in HIV-infected older children and adolescents taking antiretroviral therapy: A prospective cohort study [published online May 4, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz373