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Cardiac morbidity and related mortality in children with HIV infection
L M Luginbuhl1, E J Orav, K McIntosh
1Division of Infectious Disease, Children's Hospital, Boston, MA 02115.
Insights
Cardiac complications like heart failure and sudden death are frequent in children with human immunodeficiency virus (HIV) infection. Encephalopathy and Epstein-Barr virus coinfection significantly increase the risk of severe cardiac events in these children.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Serious cardiac complications, including dysrhythmias, hemodynamic instability, congestive heart failure, and sudden death, are known risks associated with human immunodeficiency virus (HIV) infection.
- Systematic studies on the cumulative incidence and clinical predictors of these adverse cardiac events in pediatric HIV cohorts are lacking.
Purpose of the Study:
- To determine the cumulative incidence of cardiac dysrhythmias, hemodynamic instability, congestive heart failure, and sudden death in HIV-infected children.
- To identify clinical predictors associated with these adverse cardiac outcomes in this vulnerable population.
Main Methods:
- A historical cohort study was conducted involving 81 HIV-infected children who underwent cardiac evaluations between 1984 and 1991.
- Follow-up data were collected, with initial evaluations at a median age of 1.5 years and follow-up to a median age of 3.6 years.
- Key outcomes assessed included mortality, tachycardia, bradycardia, hypertension, hypotension, sinus arrhythmia, cardiac arrest, and chronic congestive heart failure.
Main Results:
- Hemodynamic abnormalities and dysrhythmias were frequently observed in the cohort.
- Eight cardiorespiratory arrests (9%) occurred, and 10% of patients developed chronic congestive heart failure.
- Thirty children died, with 10 deaths attributed to significant cardiac dysfunction. Advanced HIV infection stages (AIDS-related complex to AIDS) correlated with increased cardiac problems.
- Nonneurologic AIDS and encephalopathy were strongly linked to severe cardiac outcomes, with encephalopathy being the strongest predictor of cardiorespiratory arrest (P = .002).
- Epstein-Barr virus coinfection was the strongest correlate of chronic congestive heart failure (P < .001).
Conclusions:
- Cardiac morbidity and mortality are significantly more prevalent in children with advanced stages of HIV infection.
- The presence of encephalopathy or Epstein-Barr virus coinfection serves as a critical indicator for identifying HIV-infected children at particularly high risk for adverse cardiac outcomes.
- These findings highlight the importance of cardiac monitoring in HIV-infected children, especially those with neurological complications or viral coinfections.
Objective:
Dysrhythmias, hemodynamic instability, congestive heart failure, and sudden death are serious complications of human immunodeficiency virus (HIV) infection that, to our knowledge, have not been studied systematically. We sought to determine the cumulative incidence and clinical predictors of these adverse events in a cohort of HIV-infected children.
Design:
Historical cohort study.
Setting:
University-affiliated, primary and tertiary care pediatric hospital and ambulatory care center.
Participants:
Eighty-one HIV-infected children who had one or more cardiac evaluations between 1984 and 1991 form the study cohort. The initial cardiac evaluation occurred at a median age of 1.5 years, and children were followed up to a median age of 3.6 years.
Main Outcome Measures:
Mortality (related to cardiac dysfunction as well as noncardiac causes), tachycardia, bradycardia, hypertension, hypotension, marked sinus arrhythmia, cardiac arrest, and chronic congestive heart failure.
Results:
Hemodynamic abnormalities and dysrhythmias occurred frequently. Eight unexpected cardiorespiratory arrests occurred in seven children (9%). Chronic congestive heart failure was noted in 10% of patients. Thirty children died, 10 with significant cardiac dysfunction. As HIV-infected children progressed from acquired immunodeficiency syndrome (AIDS)-related complex to AIDS, significant cardiac problems were more likely to occur. Both nonneurologic AIDS and encephalopathy were strongly associated with most severe cardiac outcomes. However, encephalopathy was the strongest correlate of cardiorespiratory arrest (P = .002). Epstein-Barr virus coinfection was the strongest correlate of chronic congestive heart failure (P < .001).
Conclusions:
Cardiac morbidity and mortality are more common with advanced HIV infection. The presence of encephalopathy or Epstein-Barr virus coinfection identifies HIV-infected children at especially high risk for adverse cardiac outcomes.