HIV-Infected Children on Multiple Antiretroviral Drugs Could Suffer Heart Damage
Research by Steven E. Lipshultz, M.D., yields new findings
One of the big questions surrounding the use of highly active antiretroviral therapy (HAART) for patients, especially children, with HIV has been the risk of long-term complications. New findings from research headed by Steven E. Lipshultz, M.D., professor and chairman of pediatrics and associate executive dean for child health at the Miller School, show the hearts of HIV-positive children treated with this multi-drug antiretroviral therapy had less muscle and smaller heart chambers but had increased heart function, which may be a compensation for their smaller hearts. However, there was progressive deterioration in heart function such that the HAART-associated effect was lost by 10 years of therapy.
Some of the abnormalities were sustained, and researchers found a decrease in heart muscle from normal to inadequate during the first 10 years of exposure to antiretroviral therapy.
The findings from the NIH multicenter study were presented at the Scientific Sessions of the American Heart Association on November 18 in Orlando.
In the prospective study, researchers examined periodic heart ultrasounds and compared left ventricular structure and function in HIV-positive children receiving multi-drug antiretroviral HIV therapy to HIV-positive children who were not receiving multi-drug therapy.
“The study group representing nine different institutions strongly supports the use of multi-drug antiretroviral therapy for HIV-positive children, but the group feels such patients should have regular cardiac evaluations to identify potential problems and that they should be followed for life to identify any long-term cardiac risk,” said Lipshultz, principal investigator of the study. “The clinical significance of the reduced amount of heart muscle as well as the reduced ability of the heart to pump properly over time in the HAART-exposed children is unclear and requires long-term follow-up and ongoing evaluation.”
The study, “Anti-Retroviral Therapy Cardiac Effects in HIV-Infected Children: The Multicenter NHLBI Cardiac Highly Active Antiretroviral Therapy (CHAART-II) Study,” was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health.
Dr. Lipshultz made a second presentation at the conference from the NIH Pediatric HIV/AIDS Cohort Study, which had similar findings of significantly more dilated hearts that had lower heart function in children receiving HAART long-term. They study also showed that the aortic valve in these children was dilated, and that this problem related to children who had more HIV virus and worse HIV disease.
“Sadly, before the HAART era, HIV-infected children were commonly ill or died from heart disease,” Lipshultz said. “HAART has dramatically improved survival and quality of life for these children. It does so in ways that interfere with the ability of HIV to replicate and that is beneficial to HIV-infected children because HAART reduces the HIV viral load in their bodies.
“Many HIV care providers have felt that in the HAART era, heart problems like congestive heart failure and cardiomyopathy would no longer remain concerns since there was much less virus within these children,” Lipshultz said. “However, before we did these studies we were concerned that if these same beneficial effects that reduced HIV in children occurred within heart muscle, there could be less growth of heart muscle and less healthy remaining heart muscle. In fact, before conducting these studies, components of HAART were known to affect the mitochondria and other elements of heart muscle cells in animals. The results of these two studies indicate that HAART use during childhood may be affecting the heart muscle cells’ ability to grow and function normally.”