Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, and SA MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
Western Cape Paediatric Cardiac Services and Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
J Am Soc Echocardiogr. 2020 May;33(5):604-611. doi: 10.1016/j.echo.2019.12.010. Epub 2020 Mar 5.
Little is known about the cardiac health of perinatally HIV-infected (PHIV+) adolescents on antiretroviral therapy (ART) in sub-Saharan Africa. The authors examined cardiac structure and function in PHIV+ adolescents on ART compared with HIV-uninfected (HIV-) adolescents.
Echocardiography was performed on PHIV+ and age- and sex-frequency-matched HIV- adolescents enrolled in the Cape Town Adolescent Antiretroviral Cohort. Participants were eligible if they were 9 to 14 years of age and had been on ART for ≥6 months.
Overall, 474 PHIV+ adolescents (median age, 12 years; 51% boys; mean age at ART initiation, 5 years) and 109 HIV- adolescents (median age, 11.8 years; 45% boys) were included. The mean duration on ART was 7 years, with 37% starting treatment before 2 years of age. Compared with HIV- adolescents, PHIV+ adolescents had higher median Z scores for left ventricular (LV) internal end-diastolic dimension, LV end-systolic posterior wall thickness, and end-systolic interventricular septal thickness. PHIV+ adolescents had a lower median Z score for right ventricular internal end-diastolic dimension as compared with HIV- adolescents. There was no difference in ejection fraction or diastolic function between groups. Later initiation of ART (after 6 years) was associated with increased risk for LV hypertrophy (odds ratio, 2.9; 95% CI, 1.3-6.6; P = .01) compared with those who started ART earlier. PHIV+ adolescents with World Health Organization stage IV HIV infection were at increased risk (odds ratio, 2.2; 95% CI, 1.0-4.6; P = .05) of having LV diastolic dysfunction compared with those with less advanced clinical disease.
This study revealed subtle differences in echocardiographic parameters between PHIV+ and HIV- adolescents. Although these were not clinically significant, starting ART at an older age was a significant risk factor for LV hypertrophy, while more advanced clinical disease was associated with LV diastolic dysfunction.
在撒哈拉以南非洲地区，接受抗逆转录病毒疗法（ART）的围产期感染艾滋病毒（PHIV+）青少年的心脏健康情况鲜为人知。作者比较了接受 ART 的 PHIV+青少年和未感染艾滋病毒（HIV-）的青少年的心脏结构和功能。
在开普敦青少年抗逆转录病毒队列中，对年龄和性别相匹配的 PHIV+和 HIV-青少年进行了超声心动图检查。如果参与者年龄在 9 至 14 岁之间，且已接受 ART 治疗≥6 个月，则有资格参加。
总体而言，共有 474 名 PHIV+青少年（中位年龄 12 岁，51%为男性；开始 ART 的平均年龄为 5 岁）和 109 名 HIV-青少年（中位年龄 11.8 岁，45%为男性）入组。接受 ART 的平均时间为 7 年，37%的人在 2 岁之前开始治疗。与 HIV-青少年相比，PHIV+青少年的左心室（LV）舒张末期内径、LV 收缩末期后壁厚度和收缩末期室间隔厚度的中位数 Z 评分较高。PHIV+青少年的右心室舒张末期内径中位数 Z 评分低于 HIV-青少年。两组间射血分数或舒张功能无差异。与早期开始 ART（6 年后）相比，较晚开始 ART（ART 开始时间超过 6 年）与 LV 肥厚的风险增加相关（比值比，2.9；95%置信区间，1.3-6.6；P=0.01）。与临床疾病较轻的 PHIV+青少年相比，患有世界卫生组织（WHO）IV 期 HIV 感染的 PHIV+青少年发生 LV 舒张功能障碍的风险增加（比值比，2.2；95%置信区间，1.0-4.6；P=0.05）。
本研究揭示了 PHIV+和 HIV-青少年的超声心动图参数存在细微差异。尽管这些差异没有临床意义，但年龄较大时开始 ART 是 LV 肥厚的一个显著危险因素，而更严重的临床疾病与 LV 舒张功能障碍有关。
