Prevalence of Early Cardiac Dysfunction in Children Living with Human Immunodeficiency Virus in Western Kenya
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Background: HIV-associated cardiac dysfunction has severe consequences, and traditional measures of echocardiography underestimate disease. Novel echocardiographic measures may detect early disease in time for intervention. The aims of this study are to define the prevalence of early cardiac dysfunction in children living with HIV, and the relationships between cardiac function and same-day plasma HIV RNA levels.
Methods: Using a cross-sectional study design, we performed echocardiograms and obtained plasma HIV RNA levels on perinatally HIV-infected children engaged in care at Moi Teaching and Referral Hospital in Eldoret, Kenya. Early cardiac dysfunction was defined as normal ejection fraction but left ventricular global longitudinal strain (LV GLS) z-score < -2 or myocardial performance index (MPI) ≥ 0.5. The relationship between measures of cardiac function and HIV RNA levels and the assessment of other clinical covariates (age, sex, duration on antiretrovirals, and AZT exposure) with measures of cardiac function were modeled using multivariable regression.
Results: 302 perinatally HIV-infected children (mean age 9.8±3.2 years, range 2-16 years) were enrolled. The mean BMI-for-age z-s core was -1.0±1.1. The median duration on antiretrovirals was 5.4 years (IQR 3.2, 7.6). One hundred and sixteen children (38.4%) had been exposed to AZT (median duration of exposure 2.6 years, IQR 0.2, 5.4). One hundred and one of 298 (33.9%) had HIV RNA measurements ≥ 40 copies/ml. Only 1 of 302 children had LV GLS-for-BSA z-score ≤ -2 and normal ejection fraction meeting the criteria for early cardiac dysfunction, and 65 of 292 (22.3%) children had an MPI ≥ 0.5 and normal ejection fraction. In multivariate analysis, neither LVGLS z-score nor MPI were associated with HIV RNA levels ≥ 40 copies/ml or any clinical variables in the model [β -0.08 (95%CI -0.39, 0.23) and β 0.01 (95%CI -0.01, 0.03), respectively]. MPI was very weakly correlated with LVGLS z-score (r -0.15; 95%CI -0.26, -0.04).
Conclusions: Nearly one quarter of these perinatally HIV-infected children demonstrated echocardiographic evidence of early cardiac dysfunction, based primarily on abnormal MPI measurements. This finding was not correlated with same-day HIV RNA levels or other clinically relevant variables. Further investigation into the clinical significance of this finding is urgently needed as abnormal MPI measurements have been shown to be predictive of heart failure in at risk populations.
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