Echocardiographic Assessment of Ventricular Function in Children with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy

Main Article Content

C. O. Duru
J. M. Chinawa
B. F. Chukwu

Abstract

Background: Children with Human Immunodeficiency Virus (HIV) infection could present with varying degrees of cardiac abnormalities, however the effect of Highly Active Antiretroviral Therapy (HAART) has not been extensively studied in them.

Objectives: To compare the ventricular functions of HIV positive children on HAART with that of HIV negative children using echocardiography.

 Methods: This was a comparative cross sectional descriptive study involving 54 HIV positive children on HAART and 50 HIV negative controls. Using transthoracic echocardiography, trans annular plane systolic excursion (TAPSE), Left ventricular ejection fraction (LVEF), Left ventricular fractionating shortening (LVFS), Left ventricular (LV) mitral inflow velocities, left ventricular mass index (LVMI) and Left ventricular hypertrophy (LVH) were used to assess right ventricular (RV) and left ventricular (LV) function.

Results: The mean TAPSE for subjects and controls were 26.78±5.92mm and 25.82±3.59mm respectively (t = 1.0, p = 0.32). The prevalence of right ventricular systolic dysfunction using TAPSE was significantly higher among the subjects; 29.63% compared with 8.0% in controls (χ2 = 7.82, p=0.005). There was no significant correlation between TAPSE and CD4 counts (Spearman’s correlation coefficient = 0.15, p = 0.31). The mean left ventricular mass index (LVMI) in subjects was 141.6±45.5g/M2. Forty-one (75.9%) of the subjects had left ventricular hypertrophy (LVMI > 103G/M2) compared with 26.0% (13/50) of the controls and the difference in proportion was significant (Chi-square = 30.49, p<0.001). Left ventricular systolic function was similar in subjects and controls. The prevalence of left ventricular diastolic dysfunction was significantly higher in subjects (15.5%) than in controls (4.0%); {χ2 = 37.89, p<00.1)

Conclusion: This study shows that children with HIV on HAART regimen have a very high prevalence of ventricular dysfunction compared with normal controls.

Keywords:
Ventricular function, HIV infectioN, HAART regimen, TAPSE, children, LVH.

Article Details

How to Cite
Duru, C. O., Chinawa, J. M., & Chukwu, B. F. (2021). Echocardiographic Assessment of Ventricular Function in Children with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy. Cardiology and Angiology: An International Journal, 10(1), 11-22. https://doi.org/10.9734/ca/2021/v10i130154
Section
Original Research Article

References

HIV Statistics Global and Regional Trends- UNICEF data; 2020.
Assessed: 28th December 2020.

Fantauzzi A, Mezzaroma I. Dolutegravir: Clinical efficacy and role in HIV therapy. Ther Adv Chronic Dis. 2014; 5(4):164–177.

Longo-Mbenza B, Segheri LV, Vita EK. Assessment of ventricular diastolic function in AIDS patients from Congo: A doppler echocardiographic study, Heart 1998;8: 184-94.

Longo-Mbenza B, Tonduangu K, Kintonki VE. The effect of HIV infection on high incidence of heart diseases in Kinshasa: Echocardiographic study. Ann Cardiol Angeiol. 1997;46:81-87.

Nzuobontane D, Blackett KN, Kuaban C. Cardiac involvement in HIV infected people in Yaounde, Cameroon. Postgr Med J. 2002;78:678–681.

Lubega S, Zirembusi GW, Lwabi P. Heart disease among children with HIV/AIDS attending the paediatric infectious disease clinic at Mulago Hospital. Afr Health Sci. 2005;5:219–226.

Bonnet D. Cardiovascular Complications in HIV-Infected Children. In: Barbaro G., Boccara F. (eds) Cardiovascular Disease in AIDS Springer, Milano; 2009.

Okoroma CAN, Ojo OO, Ogunkule OO. Cardiovascular dysfunction in HIV-infected children in a sub-Saharan African country: Comparative cross-sectional observational study. J Trop Paediat; 2011.
Available: tropej.oxfordjournals.org on February 3, 2020.

Barbaro G. Cardiovascular manifestations of HIV infection. JR Soc Med. 2001;94(8): 384‐390.

Idris NS, Cheung MH, Grobbee DE, Burgner D, Kurniati N, Uiterwaal C. Cardiac effects of antiretroviral-naïve versus antiretroviral-exposed HIV infection in children. PLoS ONE 2016;11:0146753.

Chanthong P, Lapphra K, Saihongthong S, Sricharoenchai S, Wittawatmongkol O, Phongsamart W et al. Echocardiography and carotid intima-media thickness among asymptomatic HIV-infected adolescents in Thailand. AIDS (London, England). 2014; 28(14): 2071–9.

Meng Q, Lima JA, Lai H, et al. Use of HIV protease inhibitors is associated with left ventricular morphologic changes and dias tolic dysfunction, J Acquir Immune Defic Syn dr, 2002;30:306-10.

Tanum J, Ishizaki A, Gatanaga H, et al. Dilated cardiomyopathy in an adult human immunodeficiency virus type 1-positive patient treated with a zidovudine-containing antiretroviral regimen. Clin Infect Dis. 2003;37:e109-e111.

Domanski MJ, Sloas MM, Follmann DA, et al. Effect of zidovudine and didanosine treatment on heart function in children infected with human immunodeficiency virus. J Pediatr, 1995;127:137-146.

Frerichs FC, Dingemans KP, Brinkman K. Cardiomyopathy with mitochondrial damage associated with nucleoside reverse-transcriptase inhibitors, N Engl J Med. 2002;347:1895-1896.

Yan Q, Jay P, Hruz PW. Acute effects of HIV protease inhibitors on the failing heart, Antivir Ther. 2006;11:L11

Fisher SD, Easley KA, Orav EJ, Colan SD, Kaplan S, Starc TJ, et al. Mild dilated cardiomyopathy and increased left ventricular mass predict mortality: the pros pective P2C2 HIV multicenter study. Am Heart J. 2005;150(3):439–47.

Harmon WG, Dadlani GH, Fisher SD, Lipshultz SE. Myocardial and pericardial disease in HIV. Curr Treat Options Cardio vasc Med. 2002;4(6):497–509.

Lipshultz SE, Miller TL, Wilkinson JD, Scott GB, Somarriba G, Cochran TR, Fisher SD. Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: A view from the United States of America. J Int AIDS Soc. 2013; 16(1):18597.
DOI: 10.7448/IAS.16.1.18597.
PMID: 23782480;
PMCID: PMC3687072.

Fisher SD, Easley KA, Orav EJ, et al. Mild dilated cardiomyopathy increased left ventricular mass predict mortality: The prospective P2C2 HIV Multicenter Study. Am Heart J. 2005;150:439-447.

Gardin JM. Wagenknecht LE. Anton-Culver H, et al. Relationship of race, sex, systolic blood pressure levels, and body mass to left ventricular mass in healthy young adults: The Cardia Study. Circula tion. 1991;84(4):133

Levy WS. Simon GL. Rios JC. Ross AM. Prevalence of cardiac abnormalities in human immunodeficiency virus infection. Am J Cardiol. 1989;63:86–89.

Friis-Møller N. Weber R. Reiss P, et al. Cardiovascular risk factors in HIV patients–association with antiretroviral therapy. Results from the DAD Study. AIDS. 2003; 17:1179–1193.

Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quan tification: A report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiograph. J Am Soc Echo cardiogr 2005;18:1440-63.

Calculation of Left ventricular mass index.
Available:http://www.csecho.ca/wp-content/themes/twentyeleven-csecho/cardiomath/?eqnHD=ech.Assessed

Available:Body Surface Area Calculator - Calculator.net

Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiography. 2009;22:715-9.

Nikmah SI, Cuno SU, David PB,Diederick EG, Nia K, Michael MH. Effects of HIV Infection on Pulmonary Artery Pressure in Children. Global Heart 2019;14:367-372

Paczyńska M, Sobieraj P, Burzyński Ł, et al. Tricuspid annulus plane systolic excursion (TAPSE) has superior predictive value compared to right ventricular to left ventricular ratio in normotensive patients with acute pulmonary embolism. Arch Med Sci. 2016;12(5):1008‐1014.
DOI: 10.5114/aoms.2016.57678

Gladwin MT, Ghofrani HA. Update on pulmonary hypertension. American Journal Respiratory Critical Care Medicne. 2009; 181:1020–1026.

Kearney DL, Perez-Atayde, AR, Easley, KA. Postmortem cardiomegaly and echocardiographic measurements of left ventricular size and function in children infected with the human immunodeficiency virus: The Prospective P2C2 HIV Multicenter Study. Cardiovasc Pathol 2003;12:140–148.

Currie PF, Boon NA. Immunopathogenesis of HIV-related heart muscle disease: Current perspectives. AIDS 2003; 17(Suppl. 1):S21–S28.

Barbaro, G, Fisher, SD, Lipshultz, SE. Pathogenesis of HIV-associated cardiovascular complications. Lancet Infect Dis. 2001;1:115–124.

Santosh KM, Sarita B, Piyush S, Kamlesh KS, Sujit K. Cardiac manifestations in HIV patients and their correlation with CD4 count.

Mondy KE, Gottdiener J, Overton ET, Henry K, Bush T, Conley L et al. High Prevalence of Echocardiographic Abnormalities among HIV-infected Persons in the Era of Highly Active Antiretroviral Therapy. Clin Infect Dis. 2011 Feb 1;52:378-86

Scott DH, Anne CM, John MW, Tony CT, Douglas JW, Kathy C et al. Protease inhibitor drug use and adverse cardiovascular outcomes in ambulatory HIV-infected persons, Lancet, 2002;360: 1747-1748.

Meng Q, Lima JA, Lai H, Vlahov D, Celentano DD. Use of HIV protease inhibitors is associated with left ventricular morphologic changes and diastolic dysfunction, J Acquir Immune Defic Syndr, 2002;30:306-310

Yan Q, Jay P, Hruz PW. Acute effects of HIV protease inhibitors on the failing heart, Antivir Ther. 2006;11:11.

Richard EK, Daniel MC. Hypertension in the high-cardiovascular-risk populations attributable risks for ischemic stroke in a community in South Brazil: a case-control study. PLoS One. 2012;7:e35680.

Ather M, Elizabeth TG, Jack D, Kathryn A, Robert CK, Jason ML. The association of HIV infection with left ventricular mass/hypertrophy. AIDS Res Hum Retroviruses. 2009;25(5): 475–481.

Seaberg EC, Mun˜oz A, Lu M, Detels R, Margolick JB, Riddler SA et al. Multicenter AIDS Cohort Study. Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003. AIDS. 2005;19:953–960.

Wislowska M, Jaszczyk B, Kochmanski M, Sypula S, Sztechman M. Diastolic heart function in RA patients. Rheumatol Int. 2008;28:513–519.

Crane HM, Van Rompaey SE, Kitahata MM. Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy. AIDS. 2006;20:1019 –1026.

Chow DC, Souza SA, Chen R, Richmond-Crum SM, Grandinetti A, Shikuma C. Elevated blood pressure in HIV-infected individuals receiving highly active antiretroviral therapy. HIV Clin Trials. 2003;4:411– 416.

Pieretti J, Roman MJ, Devereux RB, et al. Systemic lupus erythematosus predicts increased left ventricular mass. Circulation. 2007;116:419–426.

Ige OO, Oguche S, Yilgwan CS, Bode-Thomas F. Left ventricular mass and diastolic dysfunction in children infected with the human immunodeficiency virus. Nig J Cardiol 2014; 11:8-12.

Agustini NM, Gunawijaya E, Venny Kartika Yantie NP, Dewi Kumara Wati K, Ayu Witarini K, Santoso H. Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection. PI [Internet] 2019;59(3):139-.

Hsue PY, Hunt PW, Ho JE, Farah HH, Schnell A, Hoh R, et al. Impact of HIV infection on diastolic function and left ventricular mass. Circ Heart Fail. 2010; 3:132-9.

Lipshultz SE, Williams PL, Wilkinson JD, et al. Cardiac status of children infected with human immunodeficiency virus who are receiving long-term combination antire troviral therapy: Results from the adolescent master protocol of the multicenter pediatric HIV/AIDS cohort study. JAMA Pediatr. 2013;167(6):520‐ 527.