Document Detail

Cardiac effects of antiretroviral therapy in HIV-negative infants born to HIV-positive mothers: NHLBI CHAART-1 (National Heart, Lung, and Blood Institute Cardiovascular Status of HAART Therapy in HIV-Exposed Infants and Children cohort study).
MedLine Citation:
PMID:  21185505     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to investigate the possible effects of antiretroviral therapy (ART) in utero on cardiac development and function in human immunodeficiency virus (HIV)-negative children.
BACKGROUND: ART reduces vertical HIV transmission. Long-term cardiotoxicity after in utero exposure to ART is unknown in children but has occurred in young animals.
METHODS: Using a prospective multisite cohort study design, echocardiograms taken between birth and 24 months were compared in 2 groups of HIV-negative infants of HIV-positive mothers: 136 infants exposed to ART (ART+) and 216 unexposed infants (ART-).
RESULTS: Mean left ventricular (LV) mass z-scores were consistently lower in ART+ girls than in ART- girls: differences in mean z-scores were -0.46 at birth (p = 0.005), -1.02 at 6 months (p < 0.001), -0.74 at 12 months (p < 0.001), and -0.79 at 24 months (p < 0.001). Corresponding differences in z-scores for boys were smaller: 0.13 at 1 month (p = 0.42), -0.44 at 6 months (p = 0.01), -0.15 at 12 months (p = 0.37), and -0.21 at 24 months (p = 0.21). Septal wall thickness and LV dimension were smaller than expected in ART+ infants, but LV contractility was consistently about 1 SD higher at all ages (p < 0.001). In ART+ infants, LV fractional shortening was higher than in ART- infants; girls showed a greater difference.
CONCLUSIONS: Fetal exposure to ART is associated with reduced LV mass, LV dimension, and septal wall thickness z-scores and increased LV fractional shortening and contractility up to age 2 years. These effects are more pronounced in girls than in boys. Fetal ART exposure may impair myocardial growth while improving depressed LV function.
Steven E Lipshultz; William T Shearer; Bruce Thompson; Kenneth C Rich; Irene Cheng; E John Orav; Sulekha Kumar; Ricardo H Pignatelli; Louis I Bezold; Philip LaRussa; Thomas J Starc; Julie S Glickstein; Sharon O'Brien; Ellen R Cooper; James D Wilkinson; Tracie L Miller; Steven D Colan
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  57     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-27     Completed Date:  2011-03-22     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  76-85     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
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MeSH Terms
Anti-Retroviral Agents / adverse effects*,  therapeutic use
Antiretroviral Therapy, Highly Active / adverse effects
Child, Preschool
Follow-Up Studies
HIV / immunology*
HIV Seropositivity / drug therapy*
Heart / drug effects*,  embryology
Infant, Newborn
Infectious Disease Transmission, Vertical
Maternal Exposure / adverse effects*
Pregnancy Complications, Infectious / drug therapy*
Prospective Studies
Risk Factors
Ventricular Function, Left / drug effects*
Grant Support
R01 HL072705-01/HL/NHLBI NIH HHS; R01 HL072705-02/HL/NHLBI NIH HHS; R01 HL072705-03/HL/NHLBI NIH HHS; R01 HL072705-04/HL/NHLBI NIH HHS; R01 HL072705-05/HL/NHLBI NIH HHS; R01 HL072705-06/HL/NHLBI NIH HHS; R01 HL72705/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Anti-Retroviral Agents

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