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4.22.2013

Researchers Find that Combined Anti-HIV Therapies May Protect Children’s Hearts

In addition to preventing the spread and transmission of HIV, the combination drug therapies now used to treat the once-fatal virus that causes AIDS appear to protect the hearts of children born with HIV, according to a multicenter NIH-funded study led by the Miller School’s Steven E. Lipshultz, M.D.

Published online April 22 ahead of print publication in JAMA Pediatrics, the study, “Cardiac Status of Children Infected With Human Immunodeficiency Virus Who Are Receiving Long-term Combination Antiretroviral Therapy,” found that HIV-infected children who received highly active antiretroviral therapy, or HAART, for several years had healthier hearts than HIV-infected children who in the early 1990s were not treated with anti-HIV therapy, or were treated with only one drug.

“We know that before today’s robust treatments were available, HIV-positive children were more likely to have heart infections and inflammation, and many died from heart failure,” said Lipshultz, the George Batchelor Professor of Pediatrics and Director of the Batchelor Children’s Research Institute. “The findings from this research suggest that HAART, in addition to being good for treating HIV, does not appear to adversely affect the heart’s function.”

Other co-authors from the Miller School Batchelor Children’s Research Institute were James D. Wilkinson, M.D., M.P.H., professor of pediatrics and epidemiology in the Division of Pediatric Clinical Research, and Gwendolyn B. Scott, M.D., professor of pediatrics and Director of the Division of Pediatric Infectious Disease and Immunology.

Before the widespread use of HAART, heart failure was the underlying cause of death for 25 percent of HIV-infected children who died after age 10. In recent years, children infected with HIV have been treated with combinations of three or more anti-HIV medications, just like adults. Yet doctors knew little about whether the combination therapies could affect their hearts.

For this study, which was conducted as part of the NIH-supported Pediatric HIV/AIDS Cohort Study (PHACS), Lipshultz, Wilkinson, Scott and their collaborators at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Heart Lung and Blood Institute (NHLBI) and seven other institutions examined heart structure and function of more than 500 children who were born to HIV-infected mothers. They then compared the data with results from the NHLBI-sponsored Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection study of HIV-infected children, conducted in the 1990s. Lipshultz chairs the PHACS Cardiology Task Force and is a member of the PHACS Scientific Leadership Group.

Although all the children in the study, who ranged in age from 7 to 16, had been exposed to HIV before birth, some were HIV-infected and some remained HIV-uninfected. The HIV-infected children had, on average, received anti-HIV medications for at least twice as long as children in the study conducted in the 1990s. About 80 of them were treated with HAART for five years or longer. Although 17 percent of the children in the earlier study received some HAART treatment, none had received HAART for as long as five years.

Using echocardiograms to compare the heart structure and function of children who took part in the latest study to their uninfected counterparts, the researchers found that the hearts of the HIV-infected children were generally slightly less healthy. However, the HIV-infected children in the current study had healthier hearts than the children who participated in the study during the 1990s.

About 45 of the children in the 1990s study had enlarged hearts or substantial damage to the heart muscle, resulting in depressed heart function. In the HAART group, only 4 percent had heart damage and no child had symptomatic heart disease. For both groups of children, however, signs of more severe HIV infection were associated with poorer heart function.

Researchers at Harvard University, Tulane University, Baylor College and Texas Children’s Hospital in Houston, the University of Illinois at Chicago, Frontier Science Technology and Research Foundation in Amherst, N.Y., and Boston Children’s Hospital also collaborated on the study.

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