Introduction

The cardiovascular complications of HIV infection are increasingly contributing to the overall morbidity and mortality of this pediatric population. The prevalence of cardiovascular disease is estimated to be more than 90% in both symptomatic and asymptomatic HIV-infected children [1]. The spectrum of cardiovascular disorders includes abnormalities in left ventricular (LV) performance, wall thickness, and contractility; dilated cardiomyopathy; myocarditis; pericarditis; and rhythm disturbances. These children may have a wide spectrum of presenting symptoms for their cardiovascular complications, but most are initially asymptomatic. The cardiovascular symptoms may be inadvertently attributed to other causes, such as pulmonary or infectious processes, which may delay treatment. Early detection of and intervention for subclinical cardiovascular abnormalities through routine screening and monitoring will allow the clinician to initiate therapy with the goal of preventing or delaying the onset of clinical cardiovascular complications. Today the survival of pediatric HIV patients has improved and cardiac complications are increasing as the underlying cause of death (Figure 30.1) [2, 3]. Therefore, clinicians need a fundamental understanding of the cardiovascular complications that can arise from HIV infection in pediatric patients.

Risk factors

Several risk factors for cardiovascular disease among HIV-infected children have been described. The triad of encephalopathy, wasting, and low CD4+ counts in children with HIV has been shown to be associated with an increased risk of cardiovascular complications and a decreased survival [3]. Encephalopathy can lead to an autonomic neuropathy, which may precipitate arrhythmias or even sudden death [4].