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Early cardiac dysfunction in children and young adults with perinatally acquired HIV

Andrew W McCrary^1,2, Winstone M Nyandiko^3,4, Alicia M Ellis⁵

¹Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center.

AIDS (London, England)

|December 4, 2019

Insights

Nearly 28% of children and young adults with perinatally acquired HIV show early cardiac dysfunction. This dysfunction is linked to higher HIV RNA levels, zidovudine exposure, and inflammation markers like IL-6.

Area of Science:

Cardiology
Infectious Diseases
Pediatrics

Background:

Perinatally acquired HIV (PHIV) affects cardiovascular health in children and young adults.
Early identification of cardiac dysfunction is crucial for managing long-term health outcomes.

Purpose of the Study:

To determine the prevalence of early cardiac dysfunction in PHIV patients.
To identify predictors of cardiac function in this population.

Main Methods:

A cross-sectional study involving 643 individuals with PHIV (mean age 14.1 years).
Early cardiac dysfunction defined by left ventricular (LV) global longitudinal strain z-score < -2 or myocardial performance index ≥ 0.5.
Regression models analyzed relationships between cardiac function, HIV RNA, clinical factors, and inflammation markers (e.g., IL-6).

Main Results:

28% of participants exhibited early cardiac dysfunction.
Dysfunction was associated with older age, detectable HIV RNA, zidovudine (ZDV) exposure, and higher IL-6 levels.
LV ejection fraction was negatively associated with HIV RNA and ZDV exposure.
Myocardial performance index correlated positively with IL-6.

Conclusions:

A significant proportion of children and young adults with PHIV have early cardiac dysfunction.
Systemic inflammation, particularly IL-6 levels, may play a role in the development of cardiac dysfunction.
Findings highlight the need for cardiovascular monitoring in this population.

Read full analysis

Abstract

Objective:

To define the prevalence of early cardiac dysfunction in children and young adults with perinatally acquired HIV and predictors of cardiac function.

Design:

Cross-sectional design.

Methods:

Early cardiac dysfunction was defined as left ventricular (LV) global longitudinal strain z-score less than -2 or myocardial performance index at least 0.5 with normal LV ejection fraction. Regression models were fitted to assess the relationship between measures of cardiac function and HIV RNA levels, clinical variables, and markers of inflammation.

Results:

Six hundred and forty-three individuals (mean age 14.1 ± 5.2 years) were enrolled. The average time on combination antiretroviral treatment was 6.8 ± 3.6 years. Nearly 28% of individuals met criteria for early cardiac dysfunction. Individuals with early cardiac dysfunction were older (15.3 vs. 13.5 years, P < 0.001), had more frequently detectable HIV RNA (52.5 vs. 41.7%, P = 0.018), were more likely exposed to azidothymidine or zidovudine (ZDV) (55.6 vs. 41.2%, P = 0.002), and had higher median level of plasma IL-6 concentrations (1.00 vs. 0.88 pg/ml, P = 0.011). Multivariable models show LV ejection fraction negatively associated with HIV RNA levels [β -0.18; 95% confidence interval (CI) -0.33, -0.03] and ZDV exposure (β -1.75; 95% CI -2.62, -0.88) and positively associated with proportion of life on combination antiretroviral treatment (β 2.65; 95% CI 0.90, 4.41). Higher myocardial performance index was positively associated with serum inflammation marker (IL-6 β 0.01; 95% CI 0.0001, 0.001). Left ventricular global longitudinal strain was not significantly associated with clinical and laboratory variables of interest.

Conclusion:

Over one-quarter of children and young adults living with HIV demonstrated evidence of cardiac dysfunction, which may be associated with increasing levels of systemic inflammation.

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