Significance of Heart Abnormalities Underestimated in Children Who Have HIV
Findings to be explained in this week's issue of the journal Circulation
September 25, 2000
Factors such as a weakened immune system are crucial in determining the life expectancy of children who have HIV. Now, physicians have discovered the heart may also play a critical role, according to a study to be published in the Sept. 25 issue of Circulation: Journal of the American Heart Association.
For five years, physicians involved in the national, multi-center study followed 193 children who had HIV. They examined each child's heart using multiple echocardiograms - tests that create an ultrasound picture of the heart - to determine if abnormalities in the heart structure and function can independently predict death.
Physicians report that reduced heart function and increased wall thickness are risk factors for mortality in HIV-infected children, independent of other factors such as a depressed immune system. They also conclude that monitoring children who have HIV with echocardiograms may predict possible death three years in advance, giving doctors time to perform more careful examinations and try potentially effective interventions.
"This study shows that a simple, inexpensive, and noninvasive test - an echocardiogram - can help to identify HIV-infected children who are at risk of dying from HIV-related cardiac disease," says Claude Lenfant, M.D., director of the National Heart, Lung, and Blood Institute, which funded the study.
This study suggests that monitoring heart status should become part of the care of children who have HIV, says Steven Lipshultz, M.D., lead author and chief of pediatric cardiology at the University of Rochester's Children's Hospital at Strong.
"With monitoring, heart problems would be identified sooner, and doctors could start aggressive treatment that may reduce these children's suffering and perhaps prolong their lives," he says.
Until now, the increased possibility of heart failure in children who have HIV has been unclear, often causing the condition to be overlooked.
"Unfortunately, the shortness of breath that characterizes heart failure is often misdiagnosed as a lung infection, and treated with antibiotics when the children really need cardiac drugs and specialized nutritional support," Lipshultz says.
When the AIDS epidemic began, children such as those in the study - all of whom acquired HIV from their mothers - usually died by their second birthday. New treatments routinely used in developed nations have increased survival for children; in the U.S., children who are born with HIV live an average of nine years.
Children who have HIV are at increased risk for respiratory infections, such as pneumonia, so medical teams that treat them usually include pediatricians and lung specialists, but not cardiologists. Lipshultz hopes the results from this study will help extend these children's lifetimes even further.
"Heart problems in children who have HIV are very common and the amount of death and suffering they cause is sometimes under appreciated," Lipshultz says. "Aggressive treatment could reduce the suffering and give these children back some of their childhood."