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Dilation of the aortic root in children infected with human immunodeficiency virus type 1: The Prospective P2C2 HIV
W W Lai1, S D Colan, K A Easley
1Department of Pediatrics, Division of Pediatric Cardiology, Box 1201, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA. wyman.lai@mssm.edu
Insights
Aortic root dilation is observed in children with vertically transmitted human immunodeficiency virus (HIV) infection. This finding highlights the need for long-term cardiovascular monitoring in HIV-infected children.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Health
Background:
- Increased survival in human immunodeficiency virus (HIV)-infected patients leads to a greater focus on non-AIDS-defining conditions.
- Vascular lesions are increasingly recognized in HIV-infected individuals.
- Aortic root dilation has not been previously documented in HIV-infected children.
Purpose of the Study:
- To determine the prevalence of aortic root dilation in children with vertically transmitted HIV infection.
- To explore potential pathogenic mechanisms underlying aortic root dilation in this population.
Main Methods:
- Echocardiographic measurements of the aortic root were integrated into routine surveillance for 280 children born to HIV-infected mothers.
- The study included an older cohort (86 HIV-infected children) and a neonatal cohort (50 HIV-infected and 144 HIV-uninfected children).
Main Results:
- HIV-infected children showed significantly increased aortic root measurements compared to HIV-uninfected children at ages 2 and 5 years.
- Aortic root size was not significantly associated with heart rate, blood pressure, stroke volume, hemoglobin, or hematocrit.
- Aortic root dilation was associated with left ventricular dilation, higher HIV RNA levels, and lower CD4 cell counts.
Conclusions:
- Mild, nonprogressive aortic root dilation is present in children with vertically transmitted HIV infection between 2 and 9 years of age.
- Aortic root dilation in these children is linked to left ventricular dilation, increased viral load, and reduced CD4 cell counts.
- Long-term follow-up of aortic root size may be necessary for HIV-infected children due to increased survival rates.
Background:
Vascular lesions have become more evident in human immunodeficiency virus type 1 (HIV)-infected patients as the result of earlier diagnosis, improved treatment, and longer survival. Aortic root dilation in HIV-infected children has not previously been described. This study was undertaken to determine the prevalence of aortic root dilation in HIV-infected children and to evaluate some of the potential pathogenic mechanisms.
Methods:
Aortic root measurements were incorporated into the routine echocardiographic surveillance of 280 children of HIV-infected women: an older cohort of 86 HIV-infected children and a neonatal cohort of 50 HIV-infected and 144 HIV-uninfected children.
Results:
By repeated-measures analyses, mean aortic root measurements were significantly increased in HIV-infected children versus HIV-uninfected children (P values of < or =.04 and < or =.005 at 2 and 5 years of age, respectively, for aortic annulus diameter, sinuses of Valsalva, and sinotubular junction). Heart rate, systolic blood pressure, stroke volume, hemoglobin, and hematocrit were not significantly associated with aortic root size. Left ventricular dilation, increased serum HIV RNA levels, and lower CD4 cell count measurements were associated with aortic root dilation at baseline.
Conclusions:
Mild and nonprogressive aortic root dilation was seen in children with vertically transmitted HIV infection from 2 to 9 years of age. Aortic root size was not significantly associated with markers for stress-modulated growth; however, aortic root dilation was associated with left ventricular dilation, increased viral load, and lower CD4 cell count in HIV-infected children. As prolonged survival of HIV-infected patients becomes more prevalent, some patients may require long-term follow-up of aortic root size.