Sims Sanyahumbi Amy E, Hosseinipour Mina C, Guffey Danielle, Hoffman Irving, Kazembe Peter N, McCrary Madeline, Minard Charles G, van der Horst Charles, Sable Craig A
From the *Department of pediatric cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas; †Department of Infectious Disease, University of North Carolina Project, Lilongwe, Malawi, Africa; ‡Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas; §Department of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina; ¶Department of Pediatrics, Baylor College of Medicine Children's Clinical Center of Excellence, Lilongwe, Malawi, Africa; and ‖Department of Pediatric Cardiology, Children's National Medical Center, Washington, DC.
Pediatr Infect Dis J. 2017 Jul;36(7):659-664. doi: 10.1097/INF.0000000000001540.
The aims of this study were to 1) determine if cardiac disease can be detected in HIV-infected children by strain imaging and 2) to evaluate differences in exercise performance between HIV-infected children on antiretroviral therapy (ART) and HIV-infected children not yet on ART and in HIV-uninfected children by 6-minute walk tests (6MWTs).
This cross-sectional study evaluated cardiac function by echocardiogram and exercise performance by 6MWT in HIV-infected and HIV-uninfected children 4-18 years of age in Lilongwe, Malawi. Analyses compared HIV uninfected, HIV infected not yet on ART, and HIV infected on ART. Comparisons used χ(2) test, t test, analysis of variance and multiple linear regression.
No differences were found in ejection fraction, shortening fraction or strain in 73 children not yet on ART, 149 on ART and 77 HIV-uninfected controls. As viral load increased, children had worse circumferential strain. In addition, children receiving ART had better circumferential strain than those not yet on ART. Increased CD4 percentage was associated with better longitudinal strain and farther 6MWT distance. As longitudinal strain worsened, the 6MWT distance decreased. HIV-infected children not yet on ART walked a mean of 25.8 m less than HIV-uninfected children, and HIV-infected children on ART walked 25.9 m less (P = 0.015 comparing 3 groups).
HIV-uninfected children performed better on the 6MWT than HIV-infected children. Lower viral load, being on ART, and higher CD4 percentage were associated with better strain measures. Better longitudinal strain was associated with a farther 6MWT distance. Overall, ejection fraction, shortening fraction and strain measures between groups were similar, so cardiac strain did not detect cardiac dysfunction in this young population.
本研究的目的是：1）通过应变成像确定是否能在感染HIV的儿童中检测出心脏病；2）通过6分钟步行试验（6MWT）评估接受抗逆转录病毒治疗（ART）的HIV感染儿童、未接受ART的HIV感染儿童以及未感染HIV的儿童在运动能力方面的差异。
这项横断面研究通过超声心动图评估了马拉维利隆圭4至18岁的HIV感染儿童和未感染HIV儿童的心脏功能，并通过6MWT评估了他们的运动能力。分析比较了未感染HIV、未接受ART的HIV感染儿童以及接受ART的HIV感染儿童。比较采用χ²检验、t检验、方差分析和多元线性回归。
在73名未接受ART的儿童、149名接受ART的儿童和77名未感染HIV的对照儿童中，射血分数、缩短分数或应变方面未发现差异。随着病毒载量增加，儿童的圆周应变变差。此外，接受ART的儿童比未接受ART的儿童圆周应变更好。CD4百分比增加与更好的纵向应变和更远的6MWT距离相关。随着纵向应变恶化，6MWT距离缩短。未接受ART的HIV感染儿童比未感染HIV的儿童平均少走25.8米，接受ART的HIV感染儿童少走25.9米（三组比较P = 0.015）。
未感染HIV的儿童在6MWT中的表现优于感染HIV的儿童。较低的病毒载量、接受ART治疗以及较高的CD4百分比与更好的应变指标相关。更好的纵向应变与更远的6MWT距离相关。总体而言，各组之间的射血分数、缩短分数和应变指标相似，因此心脏应变在这个年轻人群中未检测出心脏功能障碍。
