AZT Doesn't Reduce Heart Function in Children at Risk of HIV

Findings to be explained in this week's New England Journal of Medicine

September 13, 2000

A potentially life-saving drug given to babies shortly before or after birth is not only a largely effective way to prevent HIV transmission from an infected mother, but one that doesn't adversely affect a child's heart, researchers say.

The findings from the national, multi-center study - funded by the National Institutes of Health - will be published Thursday, September 14, in the New England Journal of Medicine.

In 1989, physicians set out to determine whether exposure to the drug zidovudine causes abnormalities in heart function. More commonly known as AZT, the drug is used to treat people infected with - or at risk of being infected with - HIV, including the number of babies born to HIV-infected mothers. It has been shown to reduce the number of babies born with HIV by more than 60 percent.

The study included more than 600 U.S. children who were monitored closely through the use of an echocardiogram - an ultrasound of the heart - given three times annually for as many as five years. Although several previous studies suggested that the use of AZT to prevent the spread of HIV from mother to child may result in cardiac abnormalities in children, physicians involved in this study found that children treated with AZT didn't suffer any ill effects in terms of heart function.

"There is nothing at all to suggest that AZT is unsafe to the heart," says lead author Steven Lipshultz, M.D., chief of pediatric cardiology at Children's Hospital at Strong. "In developing nations, HIV is a fatal disease of early childhood. My hope is that millions of children born in developing nations will be exposed to AZT before birth, so that many of them can have a chance at a longer and more fulfilling life."

While AZT is often used in the U.S., Canada, and most of Europe, it is not routinely used in developing countries such as India and South Africa. The lack of AZT treatment in South Africa - where the rate of HIV is growing faster than anywhere in the world - received scads of media attention last year when South African President Thabo Mbeki voiced concern about giving AZT to pregnant women because of possible toxicity. While government officials said they don't have the resources to provide the preventive treatment, critics lambasted Mbeki's claim, saying he is actually unwilling to spend the money necessary to provide the potentially life-saving treatment.

Last November, the Associated Press reported that about 3.6 million people - 8 percent of the South African population - have the virus.

Lipshultz has studied HIV's affect on children's hearts since 1984, when he worked at Boston Children's Hospital. He hopes research such as this - emphasizing the benefits of AZT - will help make the drug more widely accepted throughout the world.

"This research effort is from the heart," he says. "There are only so many children you can see suffer and die from HIV without jumping in and trying to do something about it."

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