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. 2015 Jan 2;29(1):91-100.
doi: 10.1097/QAD.0000000000000499.

Cardiac effects of in-utero exposure to antiretroviral therapy in HIV-uninfected children born to HIV-infected mothers

Steven E Lipshultz  1 , Paige L Williams, Bret Zeldow, James D Wilkinson, Kenneth C Rich, Russell B van Dyke, George R Seage 3rd, Laurie B Dooley, Jonathan R Kaltman, George K Siberry, Lynne M Mofenson, William T Shearer, Steven D Colan; Pediatric HIVAIDS Cohort Study (PHACS)
Collaborators, Affiliations

Cardiac effects of in-utero exposure to antiretroviral therapy in HIV-uninfected children born to HIV-infected mothers

Steven E Lipshultz et al. AIDS. .

Abstract

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.

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Conflict of interest statement

Conflicts of Interest: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

None of the authors have any conflicts of interest or disclaimers or have received compensation regarding this study.

Figures

Figure 1
Figure 1
Echocardiographic Z-score comparisons between the SMARTT HIV-exposed uninfected (SMARTT HEU) and HIV-unexposed (SMARTT HIV-unexposed) cohorts and results from the previous NHLBI-funded CHAART and P2C2 studies. CI = confidence interval; ED = end diastolic; LV = left ventricular; ES = end systolic.
See this image and copyright information in PMC

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