Journal
AIDS
Volume 29, Issue 1, Pages 91-100Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0000000000000499
Keywords
antiretroviral drugs; cardiac; HIV; pediatrics; toxicity
Categories
Funding
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute on Drug Abuse
- National Institute of Allergy and Infectious Diseases
- Office of AIDS Research
- National Institute of Mental Health
- National Institute of Neurological Disorders and Stroke
- National Institute on Deafness and Other Communication Disorders
- National Heart Lung and Blood Institute
- National Institute of Dental and Craniofacial Research
- National Institute on Alcohol Abuse and Alcoholism
- Harvard University School of Public Health [HD052102]
- Tulane University School of Medicine [HD052104]
- National Institutes of Health [HD052102, HD052104]
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Objectives: We evaluated the potential cardiac effects of in-utero exposures to antiretroviral drugs in HIV-exposed but uninfected (HEU) children. Design and methods: We compared echocardiographic parameters of left ventricular function (ejection fraction, fractional shortening, and stress-velocity index) and structure (left ventricular dimension, posterior wall/septal thickness, mass, thickness-to-dimension ratio, and wall stress) (expressed as Z-scores to account for age and body surface area) between HEU and HIV-unexposed cohorts from the Pediatric HIV/AIDS Cohort Study's Surveillance Monitoring for ART Toxicities study. Within the HEU group, we investigated the associations between the echocardiographic Z-scores and in-utero exposures to maternal antiretroviral drugs. Results: There were no significant differences in echocardiographic Z-scores between 417 HEU and 98 HIV-unexposed children aged 2-7 years. Restricting the analysis to HEU children, first-trimester exposures to combination antiretroviral therapy (a regimen including at least three antiretroviral drugs) and to certain specific antiretroviral drugs were associated with significantly lower stress-velocity Z-scores (mean decreases of 0.22-0.40 SDs). Exposure to combination antiretroviral therapy was also associated with lower left ventricular dimension Z-scores (mean decrease of 0.44 SD). First-trimester exposure to combination antiretroviral therapy was associated with higher mean left ventricular posterior wall thickness and lower mean left ventricular wall stress Z-scores. Conclusion: There was no evidence of significant cardiac toxicity of perinatal combination antiretroviral therapy exposure in HEU children. Subclinical differences in left ventricular structure and function with specific in-utero antiretroviral exposures indicate the need for a longitudinal cardiac study in HEU children to assess long-term cardiac risk and cardiac monitoring recommendations. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
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