http://bmj.com/cgi/content/full/324/7353/1544/e
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which this article appears: HIV
Infection/AIDS Other
Cardiovascular Medicine |
Deborah Josefson Nebraska
Infants born to mothers infected with HIV sustain cardiac damage regardless of whether they contract the viral infection, a new study has found. However, although the defects tend to normalise in uninfected children, clinical follow up is still warranted, the authors conclude.
The researchers assessed heart structure and function by echocardiography in 600 newborns of HIV infected mothers and monitored the children every four to six months for up to five years. Ninety three infants had HIV and 463 infants were born uninfected. A control cohort of 195 healthy infants born to uninfected mothers was used for comparison.
Overall, HIV positive infants and children had significantly higher heart rates (mean increase of 10 beats/min, 95% confidence interval 8 to 13 beats/min) at all ages than the uninfected children and the controls. Throughout the study, the heart rates of HIV infected children were on average 13 beats/min faster than those of healthy children of healthy mothers. Heart rates of the uninfected children averaged only 3 beats/min faster.
At birth, infants born to HIV infected mothers had lower left ventricular fractional shortening (a measurement of cardiac contractility) than the healthy controls, and these deficits persisted at eight months. However, by 20 months, the uninfected infants of HIV positive mothers showed recovery, with left ventricular fractional shortening measurements on a par with the healthy controls.
Left ventricular mass at birth was similar in both infected and uninfected infants of HIV positive mothers (mean mass at entry was 13.7 g (12.8 g to 14.5 g) for infected infants and 13.2 g (12.8 g to 13.5 g) in uninfected infants), but mass continued to increase significantly only in those infants who had contracted the virus.
From 12 month to 30 month follow up, infected infants had thicker left ventricles, 3-5 g more than their uninfected cohorts. The researchers concluded that children infected with HIV have worse cardiac function than those not infected. HIV infected children show more rapid heart rates, higher left ventricular mass, and reduced cardiac contractility compared with uninfected children.
The cause of these differences are unclear but may be due to the effect of the virus on fetal development or they may be secondary to antiretroviral consumption by the mother during pregnancy.
The scientists doubt that antiretrovirals were the cause because they previously studied the effects of zidovudine use by mothers during pregnancy on newborns and found no association(New England Journal of Medicine 2000;343:759-66). They suggest that these differences could be due to autonomic dysfunction and a hyperadrenergic state, which might benefit from medications such as b blockers. They also recommend follow up for the uninfected cohort because persistent subtle anomalies may herald increased risk of heart disease later in life.
The study groups were well matched as to males and females, white v black v Hispanic infants, and had similar numbers of mothers who engaged in high risk behaviours (illicit drug use, alcohol use, and cigarette smoking) while pregnant.
The study can be viewed at
www.lancet.com
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Collections under
which this article appears:HIV
Infection/AIDS Other
Cardiovascular Medicine |
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