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Impact of Highly Active Antiretroviral Therapy on paediatric Human Immunodeficiency Virus-associated left ventricular dysfunction within the Johannesburg teaching hospital complex

Published online by Cambridge University Press:  13 February 2012

Lungile Pepeta  and
Antoinette M. Cilliers
Lungile Pepeta*
Affiliation:
Paediatrics Department, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa
Antoinette M. Cilliers
Affiliation:
Division of Paediatric Cardiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
*
Correspondence to: Dr L. Pepeta, FC Paed (SA), Cert. Cardiology (SA), Paediatrics Department, Dora Nginza Hospital, Spondo Street, Algoa Park, Port Elizabeth 6001, South Africa. Tel: +27 (0)414064327; Fax: +27 (0)413630406; E-mail: [email protected]
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Abstract

Objective

To analyse the outcome of children with left ventricular dysfunction placed on Highly Active Antiretroviral Therapy.

Method

This study is a retrospective review of records of Human Immunodeficiency Virus-positive children with left ventricular dysfunction. Demographic data were collected. Left ventricular fractional shortening, CD4 percentage, viral load, and nutritional status were compared before and during antiretroviral therapy.

Results

We reviewed the records of 34 Human Immunodeficiency Virus-positive children with left ventricular dysfunction. In all, 18 patients received antiretroviral therapy (group one) and 16 were antiretroviral therapy naive (group two). The median age of group one at initial visit was 94 months, with a male-to-female ratio of 1:1. Of those, 17 children showed improved left ventricular function on treatment, with an increase in fractional shortening (median: 17–33.5%; p less than 0.0001). There was no significant statistical difference between the groups regarding initial fractional shortening. In group one, the CD4 percentage improved (median: 12% to 30.5%; p less than 0.0001), with viral load suppression (median: 24,900 copies per millilitre to less than 25 copies per millilitre; p less than 0.0001). There was weight gain in group one (median z-score: −1.70 to −1.32; p equal to 0.0083). Proper statistical analysis in group two was not possible because of poor follow-up of patients.

Conclusion

The findings are in keeping with other reports that have shown improvement in left ventricular function in patients with Human Immunodeficiency Virus-associated cardiomyopathy treated with Highly Active Antiretroviral Therapy. Recovery of myocardial function is associated with improvement in immunological and nutritional statuses.

Keywords

Myocardial functionnutritional statusimmunological status
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 5 , 13 September 2012 , pp. 564 - 573
Copyright
Copyright © Cambridge University Press 2012

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References

1.Lipshultz, SE. Dilated cardiomyopathy in HIV infected patients. NEJM 1998; 339: 1153–1155.Google Scholar
2.Barbaro, G, Fisher, Stacy D, Lipshultz, SE. Pathogenesis of HIV-associated cardiovascular complications. Review. Lanc Infect Dis 2001; 1: 115–124.CrossRefGoogle Scholar
3.Al-Attar, I, Orav, EJ, Exil, V, Vlach, SA, Lipshultz, SE. Predictors of cardiac morbidity and mortality in children with acquired immunodeficiency syndrome. J Am Coll Cardiol 2003; 41: 1598–1605.CrossRefGoogle Scholar
4.Barbaro, G, Di Lorenzo, G, Grisorio, B, Barbarini, G. Incidence of dilated cardiomyopathy and detection of HIV in myocardial cells of HIV-positive patients. Gruppo Italiano per lo studio cardiologico dei pazienti affetti da AIDS. NEJM 1998; 339: 1093–1099.CrossRefGoogle ScholarPubMed
5.Micon, B, Jeane, DP, Maarten, S, Marchina, VE. Low prevalence of cardiac abnormalities in an HIV-seropositive population on antiretroviral combination therapy. J Acquir Immune Defic Syndr 2001; 27: 318–320.Google Scholar
6.Starc, TJ, Lipschultz, SE, Kaplan, S, et al. . Cardiac complications in children with human immunodeficiency virus infection. Pediatrics 1999; 104: e14.CrossRefGoogle ScholarPubMed
7.Barbaro, G. HIV-associated cardiomyopathy etiopathogenesis and clinical aspects. Herz 2005; 30: 486–492.CrossRefGoogle ScholarPubMed
8. Takawira FF. Spectrum of cardiac manifestations and complications in children with acquired immunodeficiency syndrome at Chris Hani Baragwanath Hospital. Research report submitted to the Faculty of Health Sciences of the University of the Witwatersrand in partial fulfilment of the requirements for the Master of Medicine in Paediatrics and Child Health degree, Johannesburg, 2000 (Unpublished Data).Google Scholar
9.Sani, MU, Okeahialam, BN, Aliyu, SH, Enoch, DA. Human immunodeficiency virus (HIV) related heart disease: a review. Wien Klin Wochenschr (Mid Euro J Med) 2005; 117/3: 73–81.Google Scholar
10.Pugliese, A, Isnardi, D, Saini, A, Scarabelli, T, Raddino, R, Torre, D. Impact of highly active antiretroviral therapy in HIV-positive patients with cardiac involvement. J Infect 2000; 40: 282–284.CrossRefGoogle ScholarPubMed
11.Barbaro, G. HIV infection, highly active antiretroviral therapy and the cardiovascular system. Review. Cardiovasc Res 2003; 60: 87–95.Google Scholar
12.Herdy, GV, Pinto, CA, Lopes, VG, et al. . Study of the cardiac alterations in HIV-infected children consequent to the antiretroviral therapy: prospective study of 47 cases. Arq Bras Cardiol 2003; 80: 311–320.Google Scholar
13.Diogenes, MS, Carvalho, AC, Succi, RC. Reversible cardiomyopathy subsequent to perinatal infection with human immunodeficiency virus. Cardiol Young 2003; 13: 373–376.CrossRefGoogle Scholar
14.Plebani, A, Esposito, S, Pinzani, R, et al. . Effect of highly active antiretroviral therapy on cardiovascular involvement in children with human immunodeficiency virus infection. Pediatr Infect Dis J 2004; 23: 559–563.Google Scholar
15.Saulsbury, FT. Resolution of organ-specific complications of human immunodeficiency virus infection in children with use of highly active antiretroviral therapy. Clin Infect Dis 2001; 32: 464–468.Google Scholar
16.Damonski, MJ, Sloas, MM, Follmann, DA, et al. . Effect of zidovudine and didanosine treatment on heart function in children infected with human immunodeficiency virus. J Pediatr 1995; 127: 137–146.CrossRefGoogle Scholar
17.Department of Health of South Africa. Guidelines for the management of HIV-infected children, Jacana Media, 2005: pp 3–14.Google Scholar
18.Starc, TJ, Lipshultz, SE, Easley, KA, et al. . Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: the prospective P2C2 HIV study. J Pediatr 2002; 141: 327–335.Google Scholar
19.Silverman, NH. Quantitative methods to enhance morphological information using M-mode, Doppler, and crossectional ultrasound. pediatric echocardiography. Williams and Wilkins, Baltimore, MD, 1993: p 38.Google Scholar
20.WHO Working Group. Use and Interpretation of Anthropometric Indicators of Nutritional Status. Bull World Health Organ. 1986; 64: 929–941.Google Scholar
21.Van Heeswijk, RPG, Veldkamp, A, Mulder, JW, et al. . Combination of protease inhibitors for the treatment of HIV-1 infected patients: a review of pharmacokinetics and clinical experience. Antivir Ther 2002; 6: 201–229.Google Scholar
22.World Health Organization. Interim WHO Clinical Staging of HIV/AIDS and HIV/AIDS Case Definitions for Surveillance, African Region 2005. http://www.who.intGoogle Scholar
23.Barbaro, G. Reviewing the cardiovascular complications of HIV infection after the introduction of highly active antiretroviral therapy. Curr Drug Targets Cardiovasc Haematol Disord 2005; 5: 337–343.CrossRefGoogle ScholarPubMed
24.Verweel, G, van Rossum, AMC, Hartwig, NG, et al. . Treatment with highly active antiretroviral therapy in immunodeficiency virus type 1-infected children is associated with a sustained effect on growth. Pediatrics 2002; 109: 1–7.CrossRefGoogle ScholarPubMed
25.Brinkman, K, ter Hofstede, HJ, Burger, DM, et al. . Adverse effects of reverse transcriptase inhibitors: mitochondrial toxicity as common pathway. AIDS 1998; 12: 1735–1744.Google Scholar
26.Behrens, GMN, Stoll, M, Schmidt, R. Lipodystrophy syndrome in HIV infection. Drug Saf 2000; 23: 57–76.Google Scholar
27.Foster, C, Lyall, H. HIV and mitochondrial toxicity in children. J Antimicrob Chemother 2008; 61: 8–12.Google Scholar
28.Frericks, FCP, Dingemans, KP, Brinkman, K. Cardiomyopathy with mitochondrial damage associated with nucleoside reverse transcriptase inhibitors. NEJM 2002; 347: 1895–1896.CrossRefGoogle Scholar
29.Lamperth, L, Dalakas, MC, Dagani, F, Anderson, J, Ferrari, R. Abnormal skeletal and cardiac muscle mitochondria induced by zidovudine (AZT) in human muscle in vitro and in an animal model. Lab Invest 1991; 65: 742–751.Google Scholar
30.Herskowitz, A, Willoughby, SB, Baughman, KL, Schulman, SP, Bartlet, JD. Cardiomyopathy associated with antiretroviral therapy in patients with HIV infection: a report of six cases. Ann Intern Med 1992; 116: 311–313.CrossRefGoogle ScholarPubMed
31.European Collaborative Study. Children born to women with HIV-1 infection: natural history and risk of transmission. Lancet 1991; 337: 253–260.CrossRefGoogle Scholar
32.Sani, MU. Myocardial disease in human immunodeficiency virus (HIV) infection: a review. Wien Klin Wochenschr 2008; 120: 77–87.Google Scholar
33.Barbaro, G. Pathogenesis of HIV-associated heart disease. AIDS 2003; 17: S12–S20.Google Scholar
34.Barbaro, G, Di Lorenzo, G, Grisorio, B, Barbarini, G. Incidence of dilated cardiomyopathy and detection of HIV in myocardial cells of HIV-positive patients. NEJM 1998; 339: 1093–1099.Google Scholar
35.Prendergast, BD. HIV and cardiovascular medicine. Heart 2003; 89: 793–800.Google Scholar
36.Calabarese, LH, Proffitt, MR, Yen-Lieberman, B, Hobbs, RE, Ratliff, NB. Congestive cardiomyopathy and illness related to the acquired immunodeficiency syndrome (AIDS) associated with isolation of retrovirus from myocardium. Ann Intern Med 1989; 107: 691–692.CrossRefGoogle Scholar
37.Grody, WW, Cheng, L, Lewis, W. Infection of the heart by the HIV. Am J Cardiol 1990; 66: 203–206.Google Scholar
38.Barbaro, G, Di Lorenzo, G, Soldini, M, et al. . Intensity of myocardial expression of inducible nitric oxide synthase influences the clinical course of human immunodeficiency virus associated cardiomyopathy. Circulation 1999; 100: 933–939.CrossRefGoogle ScholarPubMed
39.Herskowitz, A, Willoughby, S, Wu, TC, et al. . Immunopathogenesis of HIV-1 associated cardiomyopathy. Clin Immunol Immunopathol 1993; 68: 234–241.Google Scholar
40.Rodriguez, ER, Nasim, S, Hsia, J, et al. . Cardiac myocytes and dendritic cells harbor human immunodeficiency virus in infected patients with and without cardiac dysfunction: detection by multiplex, nested, polymerase chain reaction in individually microdissected cells from right ventricular endomyocardial biopsy tissue. Am J Cardiol 1991; 68: 1511–1520.Google Scholar
41.Lewis, W. Cardiomyopathy in AIDS: a pathophysiological perspective. Prog Cardiovasc Dis 2000; 43: 151–170.Google Scholar