Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2012 Oct 23;26(16):2027-37.
doi: 10.1097/QAD.0b013e3283578bfa.

The impact of HAART on cardiomyopathy among children and adolescents perinatally infected with HIV-1

Kunjal Patel  1 , Russell B Van Dyke, Murray A Mittleman, Steven D Colan, James M Oleske, George R Seage 3rd; International Maternal Pediatric Adolescent AIDS Clinical Trials 219219C Study Team
Collaborators, Affiliations
Multicenter Study

The impact of HAART on cardiomyopathy among children and adolescents perinatally infected with HIV-1

Kunjal Patel et al. AIDS. .

Abstract

Objective: Previous studies of cardiomyopathy among children perinatally infected with HIV were conducted before the routine use of HAART. Nucleoside analogs [nucleoside reverse transcriptase inhibitors (NRTIs)], the backbone of HAART, have been associated with mitochondrial toxicity, which can lead to cardiomyopathy. We evaluated the association of HAART and specific NRTIs associated with mitochondrial toxicity, on development of cardiomyopathy among perinatally HIV-infected children.

Design: Three thousand and thirty-five perinatally HIV-infected children enrolled in a US-based multicenter prospective cohort study were followed for cardiomyopathy, defined as a clinical diagnosis or initiation of digoxin, from 1993 to 2007.

Methods: Cox models were used to estimate the effects of HAART and NRTIs on cardiomyopathy, identify predictors of cardiomyopathy among HAART users, and estimate the association between development of cardiomyopathy and mortality.

Results: Ninety-nine cases of cardiomyopathy were identified over follow-up (incidence rate: 5.6 cases per 1000 person-years) at a median age of 9.4 years. HAART was associated with a 50% lower incidence of cardiomyopathy compared with no HAART use (95% confidence interval: 20%, 70%). Zalcitabine (ddC) use, however, was associated with an 80% higher incidence of cardiomyopathy. Among HAART users, older age at HAART initiation, ddC use before HAART initiation, initiating a HAART regimen containing zidovudine (ZDV), and a nadir CD4 percentage less than 15% were independently associated with a higher rate of cardiomyopathy. Cardiomyopathy was associated with a six-fold higher mortality rate.

Conclusion: HAART has dramatically decreased the incidence of cardiomyopathy among perinatally HIV-infected children. However, they remain at increased risk for cardiomyopathy and ongoing ZDV exposure may increase this risk.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

None declared.

Figures

Fig. 1
Fig. 1
Incidence rates of cardiomyopathy in the pre-HAART era (1993–1995), HAART era (1996–2007), and recent years of follow-up, PACTG 219/219C, 1993–2007.
See this image and copyright information in PMC

References

    1. Steinherz LJ, Brochstein JA, Robins J. Cardiac involvement in congenital acquired immunodeficiency syndrome. Am J Dis Child. 1986;140 (12):1241–1244. - PubMed
    1. Joshi VV, Gadol C, Connor E, Oleske JM, Mendelson J, Marin-Garcia J. Dilated cardiomyopathy in children with acquired immunodeficiency syndrome: a pathologic study of five cases. Hum Pathol. 1988;19 (1):69–73. - PubMed
    1. Johann-Liang R, Cervia JS, Noel GJ. Characteristics of human immunodeficiency virus-infected children at time of death: an experience in the 1990s. Pediatr Infect Dis J. 1997;16 (12):1145–1150. - PubMed
    1. Brady MT, Oleske JM, Williams PL, et al. Declines in mortality rates and changes in causes of death in HIV-1-infected children during the HAART era. J Acquir Immune Defic Syndr. 2010;53 (1):86–94. - PMC - PubMed
    1. Centers for Disease Control and Prevention. 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR. 1994;43(RR-12):1–10.

Publication types

MeSH terms