Idris Nikmah S, Grobbee Diederick E, Burgner David, Cheung Michael M H, Kurniati Nia, Sastroasmoro Sudigdo, Uiterwaal Cuno S P M
Department of Child Health/Centre for Clinical Epidemiology and Evidence Based Medicine (CEEBM), Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands Department of Pediatrics, University of Melbourne, Australia Murdoch Children Research Institute, Royal Children's Hospital, Melbourne, Australia
Julius Global Health, Julius Center for Health Science and Primary Care, The University Medical Center, Utrecht, The Netherlands.
Eur J Prev Cardiol. 2015 Nov;22(11):1452-61. doi: 10.1177/2047487314560086. Epub 2014 Nov 14.
HIV infection in children is now considered as a chronic condition, in which various non-infectious complications may occur, including those affecting the developing cardiovascular system. As children are expected to survive well into adulthood, understanding childhood as well as potential future cardiovascular complications is of major importance.
We reviewed published literature on childhood cardiac manifestations and longer term effects of pediatric HIV infection on the cardiovascular system. Evidence gaps that should be prioritized in research are highlighted. Through poorly understood mechanisms, HIV infection may cause various cardiac complications already manifesting in childhood, such as structural and functional myocardial derangements, pulmonary hypertension, pericardial effusion and possibly endocarditis. Evidence indicates that HIV infection in children also has unfavorable effects on the vasculature and cardiovascular biomarkers, such as increased intima-media thickness and decreased flow-mediated dilation, a marker of endothelial function. However, studies are small and predominantly include antiretroviral therapy-treated children, so that it is difficult to differentiate between effects of HIV infection per se and antiretroviral therapy treatment, reported in adults to have cardiovascular side effects.
HIV infection in children may greatly impact the cardiovascular system, including effects on the heart, which tend to manifest early in childhood, and on the vasculature. The underlying mechanisms, essential for targeted prevention, are poorly understood. Current evidence largely stems from research in adults. However, as modes of infection, immune maturity, growth and development, and treatment are markedly different in children, specific pediatric research, accounting for the complex interplay of normal growth and development, HIV infection and treatment, is clearly warranted.
儿童HIV感染目前被视为一种慢性病，可能会出现各种非感染性并发症，包括影响发育中的心血管系统的并发症。由于预计儿童能够健康存活至成年，了解儿童期以及潜在的未来心血管并发症至关重要。
我们回顾了已发表的关于儿童心脏表现以及儿科HIV感染对心血管系统长期影响的文献。强调了研究中应优先解决的证据空白。通过尚不清楚的机制，HIV感染可能导致儿童期已出现的各种心脏并发症，如心肌结构和功能紊乱、肺动脉高压、心包积液以及可能的心内膜炎。有证据表明，儿童HIV感染对血管系统和心血管生物标志物也有不利影响，如内膜中层厚度增加和血流介导的血管舒张功能降低，后者是内皮功能的一个指标。然而，研究规模较小，且主要纳入了接受抗逆转录病毒治疗的儿童，因此难以区分HIV感染本身的影响与抗逆转录病毒治疗的影响，在成人中报道抗逆转录病毒治疗有心血管副作用。
儿童HIV感染可能对心血管系统产生重大影响，包括对心脏的影响（往往在儿童期早期出现）以及对血管系统的影响。对于有针对性预防至关重要的潜在机制尚不清楚。目前的证据主要来自成人研究。然而，由于儿童的感染方式、免疫成熟度、生长发育以及治疗方法明显不同，显然有必要开展特定的儿科研究，考虑到正常生长发育、HIV感染和治疗之间的复杂相互作用。
