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Cardiac and autonomic evaluation in a pediatric population with human immunodeficiency virus
D Plein1, G Van Camp, B Cosyns
1Saint Pierre University Hospital, Cardiology Department, Brussels, Belgium.
Insights
Cardiac abnormalities and autonomic dysfunction are prevalent in children with human immunodeficiency virus (HIV) infection. Even without echocardiographic evidence, mild autonomic dysfunction may be present in pediatric HIV patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Autonomic Nervous System
Background:
- Cardiac involvement is common in children with human immunodeficiency virus (HIV) infection, particularly in advanced acquired immunodeficiency syndrome (AIDS).
- Autonomic dysfunction in pediatric HIV patients is less understood.
Purpose of the Study:
- To determine the prevalence of cardiovascular abnormalities in children with HIV.
- To assess for autonomic dysfunction in this population.
- To investigate the relationship between echocardiographic findings and autonomic involvement.
Main Methods:
- Echocardiographic abnormalities were assessed in 22 children with HIV.
- Five noninvasive tests were used to evaluate autonomic dysfunction.
Main Results:
- 18% of children had cardiac lesions, including pericardial effusion, wall motion abnormalities, and aortic endocarditis, all at CDC Stage C.
- Diastolic dysfunction was indicated by left ventricular filling pattern abnormalities.
- The Valsalva maneuver suggested mild autonomic dysfunction, even in children without echocardiographic abnormalities.
Conclusions:
- HIV-infected children exhibit a high rate of cardiac lesions.
- Autonomic dysfunction is present in pediatric HIV patients, irrespective of echocardiographic findings.
Background:
Cardiac involvement in children with human immunodeficiency virus (HIV) infection is a well-known entity and occurs clinically more often in patients with advanced acquired immunodeficiency syndrome (AIDS). Autonomic dysfunction is less known, especially in children.
Hypothesis:
The aim of this study was to asses the prevalence of cardiovascular abnormalities in a pediatric population with HIV. We also aimed to evaluate whether autonomic involvement occurs in the same population and is dependent on echocardiographic abnormalities.
Methods:
The occurrence of echocardiographic abnormalities was evaluated in 22 children with HIV infection, and five noninvasive tests were performed to evaluate the presence of autonomic dysfunction.
Results:
We found cardiac lesions in four children (18%), consisting of pericardial effusion in three children, wall motion abnormalities in three children, and acute aortic endocarditis in one child. All cardiac abnormalities were found at Stage C by Center for Disease Control (CDC) revised classification. We also found left ventricular filling pattern abnormalities consisting of E-wave maximal velocity decrease and prolonged deceleration time compatible with diastolic dysfunction. One of the five autonomic tests (Valsalva maneuver) was significantly altered, even in patients without abnormal echocardiography, suggesting mild autonomic dysfunction.
Conclusion:
The study demonstrated a high prevalence of cardiac lesions in children with HIV infection and indicated the presence of autonomic dysfunction even when there are no echocardiographically detected abnormalities.