Cardiac manifestations in HIV infected children
Pradeep Singh1, Alok Hemal, Sheetal Agarwal
1Department of Pediatrics and Neonatology, PGIMER and Ram Manohar Lohia Hospital, Delhi, 110001, India.
Insights
Cardiac involvement in children with HIV/AIDS is often subclinical, with echocardiography detecting diastolic and systolic dysfunction. Early detection is crucial for preventing severe outcomes in pediatric HIV patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Manifestations of HIV
Background:
- Cardiac involvement is a known complication in Human Immunodeficiency Virus (HIV) infection.
- Understanding the spectrum and prevalence of cardiac issues in pediatric HIV is essential for management.
Purpose of the Study:
- To investigate the occurrence and characteristics of cardiac involvement in children infected with HIV.
- To describe the cardiac spectrum using non-invasive diagnostic tools like ECG and 2-D Echocardiography.
Main Methods:
- A cross-sectional observational study was conducted on 100 children (1-18 years) with HIV.
- Cardiac status was assessed through clinical examination, electrocardiogram (ECG), and 2-Dimensional Echocardiography (2-D ECHO).
Main Results:
- Most patients were male (74%) with a mean age of 9.62 years; 86% were on HAART.
- While clinically suspected cardiac involvement was low (9%), ECG showed abnormalities in 14%.
- Echocardiography revealed left ventricular diastolic dysfunction (64%), systolic dysfunction (37%), abnormal mass (29%), pericardial effusion (2%), and dilated cardiomyopathy (2%).
Conclusions:
- Cardiac involvement in pediatric HIV/AIDS is frequently subclinical, manifesting as systolic and diastolic dysfunction.
- Echocardiography is the primary tool for diagnosing cardiac involvement in HIV-infected children.
- Early diagnosis and intervention are vital to mitigate cardiac morbidity and mortality in this population.
Objective:
To determine the occurrence of cardiac involvement in HIV infected children and describe its spectrum using non-invasive tests like ECG and 2-Dimensional Echocardiography (2-D ECHO).
Methods:
A cross sectional observational study was carried out on 100 HIV infected children between 1 and 18 y of age. The various cardiac manifestations were determined clinically, by electrocardiogram (ECG) and 2-D echocardiography.
Results:
Seventy four percent of the patients were males with a mean age of 9.62 ± 3.62 y. Seventy seven percent children were in WHO stage I. Sixty five percent did not have significant immune suppression. Eighty six percent children were on HAART (mean duration- 35.12 ± 29.48 mo). Fifty nine percent of children were symptomatic and only nine patients were clinically suspected to have cardiac involvement. ECG abnormalities were found in 14 % cases. The most common abnormal echocardiographic finding was left ventricular diastolic dysfunction by tissue Doppler (E/E') observed in 64 % cases followed by systolic dysfunction (37 %), abnormal left ventricular mass (29 %), pericardial effusion (2 %) and dilated cardiomyopathy (2 %); 64.2 % cases with left ventricular systolic dysfunction (LVSD) were in WHO stage III.
Conclusions:
Involvement of heart in HIV/AIDS is mostly subclinical. HIV myocarditis produces systolic as well as diastolic dysfunction. At present, echocardiography remains the only tool for identifying heart involvement in HIV-infected children. Early diagnosis and intervention may halt the progression of the disease, thereby preventing morbidity and mortality.
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