Sainz Talía, Álvarez-Fuente María, Fernández-Jiménez Rodrigo, González-Tomé María Isabel, de José María Isabel, Ramos José Tomás, Navarro María Luisa, Martínez Jorge, García-Hortelano Milagros, Medrano Constancio, Muñoz-Fernández María Ángeles, Mellado María José
From the *Laboratorio de Inmunobiología Molecular, Hospital General Universitario Gregorio Marañón; †Instituto de Investigación Sanitaria Gregorio Marañón; ‡Unidad de Cardiología Infantil, Hospital General Universitario Gregorio Marañón; §Imaging in Experimental Cardiology Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III; ¶Unidad de Inmunodeficiencias, Servicio de Pediatría, Hospital Universitario Doce de Octubre; ‖Servicio de Pediatría, Hospital Universitario La Paz; **Servicio de Pediatría, Hospital de Getafe; ††Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón; ‡‡Servicio de Pediatría, Hospital Universitario Niño Jesús; and §§Servicio de Pediatría, Hospital Carlos III and Servicio de Pediatría, Hospital La Paz, Madrid, Spain.
Pediatr Infect Dis J. 2015 May;34(5):e125-31. doi: 10.1097/INF.0000000000000634.
Previous studies have demonstrated increased risk of adverse cardiac outcomes in adults with HIV infection. However, few studies have addressed this problem in vertically HIV-infected children and adolescents, and the long-term cardiac health of this unique population in the antiretroviral therapy era is still unknown.
Ventricular function was evaluated cross-sectionally in a group of HIV-infected children and adolescents and healthy controls, using conventional echocardiography along with tissue Doppler imaging and strain analysis by speckle tracking. Simultaneously, measurements of carotid intima-media thickness were performed.
A total of 64 cases and 58 controls were included, mean age was 13.6 ± 5.4 years and 64% were females. All but 2 patients were on antiretroviral treatment, and 64% had undetectable viral load. HIV-infected patients showed higher intima-media thickness (0.425 ± 0.019 vs. 0.415 ± 0.019 mm, P = 0.003). Statistically significant differences were found between groups in ejection fraction and fractional shortening (66.1% and 36.2% in the HIV-infected group vs. 71.5% and 40.8% in the control group, respectively, P = 0.001), although individual values fell within or near normal ranges. There were no significant differences in diastolic function, tissue Doppler imaging or cardiac strain (longitudinal and rotational) between both groups. No associations were identified between echocardiographic parameters and current CD4+ T-lymphocyte counts, CD4+ T-lymphocyte nadir, HIV viral load, duration or type of antiretroviral treatment regimens.
In a context of highly effective antiretroviral treatment, no differences were found regarding cardiac abnormalities using conventional and advanced ultrasound imaging techniques in this cohort of vertically HIV-infected children and adolescents, when compared with healthy controls.
既往研究表明，成人HIV感染者发生不良心脏结局的风险增加。然而，很少有研究探讨垂直感染HIV的儿童和青少年中的这一问题，并且在抗逆转录病毒治疗时代，这一特殊人群的长期心脏健康状况仍不明确。
采用传统超声心动图以及组织多普勒成像和斑点追踪应变分析，对一组HIV感染儿童和青少年以及健康对照进行心室功能的横断面评估。同时，测量颈动脉内膜中层厚度。
共纳入64例病例和58例对照，平均年龄分别为13.6±5.4岁和64%为女性。除2例患者外，所有患者均接受抗逆转录病毒治疗，64%的患者病毒载量检测不到。HIV感染患者的内膜中层厚度更高（0.425±0.019 vs. 0.415±0.019 mm，P = 0.003）。两组间射血分数和缩短分数存在统计学显著差异（HIV感染组分别为66.1%和36.2% vs.对照组的71.5%和40.8%，P = 0.001），尽管个体值均在正常范围内或接近正常范围。两组间舒张功能、组织多普勒成像或心脏应变（纵向和旋转）无显著差异。未发现超声心动图参数与当前CD4+T淋巴细胞计数、CD4+T淋巴细胞最低点、HIV病毒载量、抗逆转录病毒治疗方案的持续时间或类型之间存在关联。
在高效抗逆转录病毒治疗的背景下，与健康对照相比，在这组垂直感染HIV的儿童和青少年中，使用传统和先进的超声成像技术未发现心脏异常方面的差异。
