This article is more than 5 years old. Information may no longer be current.
Fetal antiretroviral therapy exposure may impair myocardial growth, improve depressed LV function
Lipshultz S. J Am Coll Cardiol. 2011;57:76–85.
Click Here to Manage Email Alerts
Fetal exposure to antiretroviral therapy led to reductions in left ventricular mass and dimension and septal wall thickness, as well as increased left ventricular fractional shortening and contractility. Researchers concluded that exposure to this therapy may cause impairments to myocardial growth while also causing improvements to depressed left ventricular function.
“Abnormalities of LV structure and function are associated with HIV infections, possibly with antiretroviral therapy (ART), and even mild abnormalities independently predict mortality in HIV-infected children,” Steven E. Lipshultz, MD, study investigator, and colleagues wrote. “Nearly 10,000 ART-exposed and HIV-exposed but negative infants are born annually in the US, but are not routinely followed for suspicion of heart disease.”
The US-based researchers analyzed two cohorts of HIV-negative children born to HIV-positive mothers to study the cardiac effects of perinatal exposure to ART. The final study population included 136 ART-exposed, HIV-negative infants from the CHAART-1 trial and 216 non-ART-exposed, HIV-negative infants from the P2C2 HIV study.
According to researchers, unadjusted LV mass z score for CHAART-1 infants at 2 years of age was 0.53 standard deviation (SD) less than in the P2C2 HIV cohort (P=.006), an association that remained, even after adjusting for factors such as sex and ethnicity. Conversely, at 2 years of age, unadjusted LV fractional shortening z score for the ART-exposed infants was 0.45 SD more than that of the non-exposed infants (P=.01). Researchers also reported that septal wall thickness and LV dimension were smaller than expected in ART-exposed infants, but LV contractility was roughly 1 SD higher at all ages (P<.001).
Based on this data, “We speculate that in utero exposure to ART may impair myocardial growth while initially improving LV function, although LV function was less than normal. These effects are more pronounced in girls,” the researchers wrote. “These findings clearly indicate a need for long-term monitoring of these infants to better define the mechanism of these effects and to evaluate their long-term clinical importance.”
Disclosure: Dr. Lipshultz reports no relevant financial disclosures.
 |
Follow InfectiousDiseaseNews.com on Twitter. |