Article ID Journal Published Year Pages File Type
2950644 Journal of the American College of Cardiology 2011 10 Pages PDF
Abstract

ObjectivesThe 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.BackgroundART reduces vertical HIV transmission. Long-term cardiotoxicity after in utero exposure to ART is unknown in children but has occurred in young animals.MethodsUsing 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−).ResultsMean 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.ConclusionsFetal 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.

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