HAART to heart for children with HIV
medwireNews: Long-term highly active antiretroviral therapy (HAART) appears to protect children with HIV from associated cardiac problems, suggest study findings.
"Our results indicate that the current use of combination ART, usually HAART, appears to be cardioprotective in HIV-infected children and adolescents," say Steven Lipshultz (University of Miami, Florida, USA) and colleagues.
"This finding is even more relevant in the developing world where the prevalence of HIV disease in children is much higher," they add in JAMA Pediatrics.
The team compared three groups of children - 325 perinatally infected with HIV receiving HAART, 189 HIV-exposed but uninfected, and 70 historical HIV-infected controls who did not receive long-term HAART - to assess links between HAART and cardiac function.
Echocardiograms were available for 72% of the children with HIV (HAART and historical groups combined) and 83% of HIV-exposed but uninfected children at mean ages of 13.0, 9.7, and 11.0 years, respectively. At the time the echocardiograms were completed, 89% of the HAART group and 17% of the historical controls were receiving HAART. In addition, 80% versus 0% of children in the corresponding groups had been receiving the therapy for at least 5 years.
The researchers found that crude left ventricular (LV) contractility z-score was significantly lower in the historical controls than in the HAART group, at -1.53 versus 0.19, and highest in the HIV-exposed but uninfected children, at 0.26. Similarly, mean LV fractional shortening z-score was lowest in the historical controls, at -1.95, compared with 0.09 and 0.35 in the HAART and HIV-exposed but uninfected children, respectively.
Measurements for LV mass, LV end-systolic dimension, and LV end-diastolic dimension mean z-scores, were all lowest in HIV-exposed but uninfected children, intermediate in HAART-treated children, and highest in historical controls. Similar trends were seen for other cardiac measurements.
Notably, 44.0% of the historical controls met the definition for cardiomyopathy (z-score less than -2 for LV fractional shortening or LV dimension greater than 2), compared with 3.7% of the HAART cohort, and 1.6% of the HIV-exposed but uninfected group.
"Examining the associations between individual ART agents and combinations of ART might identify optimal ART regimens, both in terms of optimizing HIV outcomes and protecting long-term cardiac health and represents a future research opportunity using this data set," say the authors.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Helen Albert, Senior medwireNews Reporter