Domanski M J, Sloas M M, Follmann D A, Scalise P P, Tucker E E, Egan D, Pizzo P A
Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA.
J Pediatr. 1995 Jul;127(1):137-46. doi: 10.1016/s0022-3476(95)70275-x.
Human immunodeficiency virus (HIV) infection in children can be complicated by the development of cardiac disease. Decreased left ventricular function has been temporally associated with the use of zidovudine (azidothymidine; AZT) in adults with HIV and has been associated with changes in cardiac muscle mitochondria in animal models. This study was done in an attempt to determine whether the cardiac disease is related to the antiretroviral therapy or to progressive HIV infection.
We retrospectively reviewed echocardiograms, clinical records, and laboratory data from 137 HIV-infected children who were being treated by the Pediatric Branch, National Cancer Institute, and who were receiving AZT or didanosine, both drugs, or no antiretroviral therapy.
Despite correction of the echocardiographic results for HIV disease severity with markers such as CD4+ lymphocyte count, time since infection, mode of acquisition of HIV, and age, children who were treated with AZT had a lower average fractional shortening than those who were not treated with AZT (p < 0.00001). There was a nonlinear relation between days of AZT use and this There was a nonlinear relation between days of AZT use and this decrease in fractional shortening. The odds that a cardiomyopathy would develop was 8.4 times greater in children who had previously used AZT than in those who had never taken AZT (95% confidence interval, 1.7 to 42.0). Didanosine was not associated with the development of a cardiomyopathy.
Treatment of HIV-infected children with AZT may be associated with the development of a cardiomyopathy; didanosine does not appear to increase the risk of cardiomyopathy. The continued use of AZT in a child in whom a cardiomyopathy develops should be carefully assessed, and all children receiving AZT should be followed by serial cardiac examination and echocardiograms.
儿童人类免疫缺陷病毒（HIV）感染可能并发心脏疾病。左心室功能下降在时间上与HIV感染成人使用齐多夫定（叠氮胸苷；AZT）有关，并且在动物模型中与心肌线粒体变化有关。本研究旨在确定心脏疾病是与抗逆转录病毒疗法有关还是与HIV的进展性感染有关。
我们回顾性分析了美国国立癌症研究所儿科分部正在治疗的137名HIV感染儿童的超声心动图、临床记录和实验室数据，这些儿童正在接受AZT或去羟肌苷治疗、两种药物联合治疗或未接受抗逆转录病毒治疗。
尽管使用CD4 +淋巴细胞计数、感染时间、HIV感染途径和年龄等指标对超声心动图结果进行了HIV疾病严重程度校正，但接受AZT治疗的儿童平均缩短分数低于未接受AZT治疗的儿童（p < 0.00001）。AZT使用天数与缩短分数的降低之间存在非线性关系。曾使用过AZT的儿童发生心肌病的几率是从未使用过AZT儿童的8.4倍（95%置信区间，1.7至42.0）。去羟肌苷与心肌病的发生无关。
用AZT治疗HIV感染儿童可能与心肌病的发生有关；去羟肌苷似乎不会增加心肌病的风险。对于已发生心肌病的儿童继续使用AZT应谨慎评估，所有接受AZT治疗的儿童都应定期进行心脏检查和超声心动图检查。
