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Published on: June 12, 2020
Effects of paediatric HIV infection on electrical conduction of the heart
Nikmah S Idris1, Michael M H Cheung2, Diederick E Grobbee3
1Faculty of Medicine University of Indonesia-Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta, Indonesia; Julius Global Health, Julius Centre for Health Sciences and Primary Care, the University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute; Royal Children's Hospital, Melbourne, Australia.
Insights
HIV infection in children prolongs heart electrical conduction, specifically QTc intervals in both treatment-naïve and exposed groups. Longer PR intervals were observed only in treatment-naïve HIV-infected children.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Electrophysiology
Background:
- Human immunodeficiency virus (HIV) infection can impact multiple organ systems, including the cardiovascular system.
- Understanding the specific effects of HIV on cardiac electrical conduction in children is crucial for management.
- Differentiating between the effects of HIV infection itself and antiretroviral therapy (ART) is important for accurate assessment.
Purpose of the Study:
- To investigate the impact of HIV infection on cardiac electrical conduction in children.
- To distinguish the effects of HIV infection from the effects of antiretroviral therapy (ART) on heart electrical parameters.
- To evaluate specific ECG intervals, including PR, QRS, and QTc, in HIV-infected children.
Main Methods:
- A 12-lead electrocardiogram (ECG) was performed on three groups of children in Jakarta, Indonesia: ART-naïve HIV-infected (n=37), ART-exposed vertically-acquired HIV-infected (n=42), and healthy controls (n=50).
- Cardiac conduction parameters, including PR, QRS, and Bazett's corrected QTc intervals, were measured.
- General linear modeling was used to assess associations between HIV status and ECG intervals, adjusting for confounders.
Main Results:
- Mean QTc intervals were significantly longer in both ART-naïve (18.2 ms difference) and ART-exposed (28.9 ms difference) HIV-infected children compared to healthy controls.
- Prolongation of the PR interval was observed exclusively in ART-naïve HIV-infected children (12.9 ms difference).
- No significant differences in QRS intervals were found between the groups.
Conclusions:
- HIV infection is associated with QTc interval prolongation in children, with a more pronounced effect in those exposed to ART.
- PR interval prolongation is specifically linked to ART-naïve HIV infection in pediatric populations.
- These findings highlight the cardiac electrical consequences of HIV infection and its treatment in children.
Objective:
To investigate the effects of HIV infection in children on heart electrical conduction, particularly to delineate the effects of HIV infection from treatment.
Methods:
On a 12-lead ECG, available for 37 antiretroviral therapy (ART) naïve, 42 ART-exposed vertically-acquired HIV-infected and 50 healthy children in Jakarta, Indonesia, we measured cardiac conduction parameters: PR, QRS, and QTc (corrected using Bazett's formula) intervals. The associations between HIV infection/treatment status and ECG intervals were evaluated using general linear modelling with further adjustment for potential confounders or intermediary variables. Findings are presented as (adjusted) mean differences between each of the two HIV groups and healthy children.
Results:
Although not exceeding the clinical threshold for long QT (QTc >460 ms for girls and >440 ms for boys) compared to healthy children, mean QTc intervals were longer in ART-naïve (difference 18.2 ms, 95% CI 7.0 to 29.3) and, to greater extent, in ART-exposed HIV-infected children (difference 28.9 ms, 19.3 to 38.5). Following adjustment for RR interval, age and height, prolongation of PR interval was seen only in ART-naïve HIV-infected children (difference 12.9 ms, 2.4 to 23.3). Cardiac mass/function, high-sensitive C reactive protein, cholesterol and glycated haemoglobin levels, systolic and diastolic blood pressures, or postnatal parental smoking exposure did not affect these associations. No difference in the QRS interval was observed between groups.
Conclusions:
Prolongation of the QTc interval occurs in ART-naïve HIV-infected children and, to a greater extent, in the ART-exposed children, whereas a longer PR interval appears to be seen only among ART-naïve HIV-infected children.
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