TY - JOUR
T1 - Cardiac effects of in-utero exposure to antiretroviral therapy in HIV-uninfected children born to HIV-infected mothers
AU - Pediatric HIV/AIDS Cohort Study (PHACS)
AU - Lipshultz, Steven E.
AU - Williams, Paige L.
AU - Zeldow, Bret
AU - Wilkinson, James D.
AU - Rich, Kenneth C.
AU - Van Dyke, Russell B.
AU - Seage, George R.
AU - Dooley, Laurie B.
AU - Kaltman, Jonathan R.
AU - Siberry, George K.
AU - Mofenson, Lynne M.
AU - Shearer, William T.
AU - Colan, Steven D.
AU - Paul, Mary
AU - Cooper, Norma
AU - Harris, Lynette
AU - Purswani, Murli
AU - Stuard, Emma
AU - Cintron, Anna
AU - Puga, Ana
AU - Cooley, Dia
AU - Patton, Doyle
AU - Leon, Deyana
AU - Rutstein, Richard
AU - Vincent, Carol
AU - Silverman, Nancy
AU - Yogev, Ram
AU - Sanders, Margaret Ann
AU - Malee, Kathleen
AU - Hunter, Scott
AU - Wiznia, Andrew
AU - Burey, Marlene
AU - Nozyce, Molly
AU - Borkowsky, William
AU - Deygoo, Sandra
AU - Rozelman, Helen
AU - Knapp, Katherine
AU - Allison, Kim
AU - Wilkins, Megan
AU - Acevedo-Flores, Midnela
AU - Angeli-Nieves, Lourdes
AU - Olivera, Vivian
AU - Mendez, Hermann
AU - Dennie, Ava
AU - Bewley, Susan
AU - Nachman, Sharon
AU - Oliver, Margaret
AU - Craig, Karen
AU - Sirois, Patricia
AU - Crain, Marilyn
N1 - Publisher Copyright:
© 2014 Wolters Kluwer Health. © Lippincott Williams & Wilkins.
PY - 2015
Y1 - 2015
N2 - 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-todimension 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 417HEUand 98 HIV-unexposed children aged 2-7 years. Restricting the analysis toHEU 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 .
AB - 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-todimension 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 417HEUand 98 HIV-unexposed children aged 2-7 years. Restricting the analysis toHEU 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 .
KW - Antiretroviral drugs
KW - Cardiac
KW - HIV
KW - Pediatrics
KW - Toxicity
UR - http://www.scopus.com/inward/record.url?scp=84928011688&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84928011688&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000000499
DO - 10.1097/QAD.0000000000000499
M3 - Article
C2 - 25562493
AN - SCOPUS:84928011688
SN - 0269-9370
VL - 29
SP - 91
EP - 100
JO - AIDS
JF - AIDS
IS - 1
ER -