Study Links Treatment to Prevent HIV Transmission to Newborns to Cardiac Problems
The use of antiretroviral therapy (ART) in HIV-positive pregnant women reduces the chance of HIV transmission to the unborn child, but a newly published study by University of Miami Miller School of Medicine Department of Pediatrics researchers and others is raising questions about the cardiac effects of that treatment. The findings are published in the December 28 issue of the Journal of the American College of Cardiology.
Nearly 10,000 ART-exposed and HIV-exposed but negative infants are born each year in the United States but are not routinely followed for suspicion of heart disease related to the therapy. To examine the possible cardiac effects of perinatal exposure to ART, the researchers compared 2 cohorts of HIV-negative children born to HIV-positive mothers. The children were part of CHAART-1, which is the National Heart, Lung, and Blood Institute Cardiovascular Status of HAART Therapy in HIV-Exposed Infants and Children Cohort Prospective Multicenter Study.
“What we found in reviewing the data was that fetal exposure to ART is associated with such cardiac abnormalities as reduced LV mass, dimension, and septal wall thickness and higher LV fractional shortening and contractility during the first 2 years of life,” said Steven E. Lipshultz, M.D., professor and chair of pediatrics at the Miller School and lead author and principal investigator of the study. “These effects are more pronounced in girls. With so many infants exposed to ART, our findings clearly show the need for more long-term monitoring of these infants, while we may be preventing HIV transmission, are we trading that for a lifetime of cardiac problems.”
The researchers said they were pleased to discover that the HIV-uninfected children exposed to antiretroviral therapy did have better early LV function, but as Lipshultz pointed out, “although the health of these children’s heart muscle is better initially, their ability to grow the appropriate amount of cardiac muscle eventually become impaired and reduced due to exposure to agents that are known to block growth.”
Tracie Miller, M.D., professor of pediatrics and director of pediatric clinical research, and James Wilkinson, M.D., M.P.H., professor of pediatrics, also served as authors of the study.