This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lipshultz, S. E. Articles by Colan, S. D. Search for Related Content PubMed PubMed Citation Articles by Lipshultz, S. E. Articles by Colan, S. D. Related Collections Structure Contractile function Myocardial cardiomyopathy disease Echocardiography Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2000;102:1542.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Cardiac Dysfunction and Mortality in HIV-Infected Children

The Prospective P²C² HIV Multicenter Study

Steven E. Lipshultz, MD; Kirk A. Easley, MS; E. John Orav, PhD; Samuel Kaplan, MD; Thomas J. Starc, MD, MPH; J. Timothy Bricker, MD; Wyman W. Lai, MD, MPH; Douglas S. Moodie, MD; George Sopko, MD, MPH; Steven D. Colan, MD; for the Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection (P²C² HIV) Study Group

From the Division of Pediatric Cardiology (S.E.L.), University of Rochester Medical Center and Children’s Hospital at Strong and Department of Pediatrics (S.E.L.), University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Cardiology (S.E.L., S.D.C.), Children’s Hospital, Department of Pediatrics, Harvard Medical School (S.E.L., S.D.C.), Department of Pediatrics, Boston Medical Center and Boston University School of Medicine (S.E.L.), and Department of Medicine, Brigham and Woman’s Hospital (E.J.O.), Boston, Mass; Department of Biostatistics and Epidemiology (K.A.E.) and Department of Pediatrics, Division of Pediatric Cardiology (D.S.M.), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Pediatrics, Division of Pediatric Cardiology, University of California, Los Angeles Medical Center and School of Medicine, Los Angeles (S.K.); Department of Pediatrics, Division of Pediatric Cardiology, Mt Sinai School of Medicine (W.W.L.), and Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University College of Physicians and Surgeons (T.J.S.), New York, NY; Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex (J.T.B.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (G.S.).

Correspondence to Dr Steven E. Lipshultz, Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 631, Rochester, NY 14642. E-mail steve_lipshultz{at}urmc.rochester.edu

Background—Left ventricular (LV) dysfunction is common in children infected with the human immunodeficiency virus (HIV), but its clinical importance is unclear. Our objective was to determine whether abnormalities of LV structure and function independently predict all-cause mortality in HIV-infected children.

Methods and Results—Baseline echocardiograms were obtained on 193 children with vertically transmitted HIV infection (median age, 2.1 years). Children were followed up for a median of 5 years. Cox regression was used to identify measures of LV structure and function predictive of mortality after adjustment for other important demographic and baseline clinical risk factors. The time course of cardiac variables before mortality was also examined. The 5-year cumulative survival was 64%. Mortality was higher in children who, at baseline, had depressed LV fractional shortening (FS) or contractility; increased LV dimension, thickness, mass, or wall stress; or increased heart rate or blood pressure (P0.02 for each). Decreased LV FS (P<0.001) and increased wall thickness (P=0.004) were also predictive of increased mortality after adjustment for CD4 count (P<0.001), clinical center (P<0.001), and encephalopathy (P<0.001). FS showed abnormalities for up to 3 years before death, whereas wall thickness identified a population at risk only 18 to 24 months before death.

Conclusions—Depressed LV FS and increased wall thickness are risk factors for mortality in HIV-infected children independent of depressed CD4 cell count and neurological disease. FS may be useful as a long-term predictor and wall thickness as a short-term predictor of mortality.

Key Words: viruses • mortality • pediatrics • AIDS

This article has been cited by other articles:

				C. L. McDonald and J. R. Kaltman Cardiovascular disease in adult and pediatric HIV/AIDS. J. Am. Coll. Cardiol., September 22, 2009; 54(13): 1185 - 1188. [Full Text] [PDF]

				S. K. Grinspoon, C. Grunfeld, D. P. Kotler, J. S. Currier, J. D. Lundgren, M. P. Dube, S. E. Lipshultz, P. Y. Hsue, K. Squires, M. Schambelan, et al. State of the Science Conference: Initiative to Decrease Cardiovascular Risk and Increase Quality of Care for Patients Living With HIV/AIDS: Executive Summary Circulation, July 8, 2008; 118(2): 198 - 210. [Full Text] [PDF]

				M. P. Dube, S. E. Lipshultz, C. J. Fichtenbaum, R. Greenberg, A. D. Schecter, S. D. Fisher, and for Working Group 3 Effects of HIV Infection and Antiretroviral Therapy on the Heart and Vasculature Circulation, July 8, 2008; 118(2): e36 - e40. [Full Text] [PDF]

				P. W. Hruz, Q. Yan, H. Struthers, and P. Y. Jay HIV protease inhibitors that block GLUT4 precipitate acute, decompensated heart failure in a mouse model of dilated cardiomyopathy FASEB J, July 1, 2008; 22(7): 2161 - 2167. [Abstract] [Full Text] [PDF]

				P. Y. Hsue and D. D. Waters What a Cardiologist Needs to Know About Patients With Human Immunodeficiency Virus Infection Circulation, December 20, 2005; 112(25): 3947 - 3957. [Abstract] [Full Text] [PDF]

				S. E. Lipshultz and T. L. Miller Establishing norms for echocardiographic measurements of cardiovascular structures and function in children J Appl Physiol, August 1, 2005; 99(2): 386 - 388. [Full Text] [PDF]

				S. E. Lipshultz, S. R. Lipsitz, S. E. Sallan, V. M. Dalton, S. M. Mone, R. D. Gelber, and S. D. Colan Chronic Progressive Cardiac Dysfunction Years After Doxorubicin Therapy for Childhood Acute Lymphoblastic Leukemia J. Clin. Oncol., April 20, 2005; 23(12): 2629 - 2636. [Abstract] [Full Text] [PDF]

				S. M. Mone, M. W. Gillman, T. L. Miller, E. H. Herman, and S. E. Lipshultz Effects of Environmental Exposures on the Cardiovascular System: Prenatal Period Through Adolescence Pediatrics, April 1, 2004; 113(4/S1): 1058 - 1069. [Abstract] [Full Text] [PDF]

				H. Kan, Z. Xie, and M. S. Finkel p38 MAP kinase-mediated negative inotropic effect of HIV gp120 on cardiac myocytes Am J Physiol Cell Physiol, January 1, 2004; 286(1): C1 - C7. [Abstract] [Full Text] [PDF]

				B D Prendergast HIV AND CARDIOVASCULAR MEDICINE Heart, July 1, 2003; 89(7): 793 - 800. [Full Text] [PDF]

				I. Al-Attar, E. J. Orav, V. Exil, S. A. Vlach, and S. E. Lipshultz Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1598 - 1605. [Abstract] [Full Text] [PDF]

				D Nzuobontane, K N Blackett, and C Kuaban Cardiac involvement in HIV infected people in Yaounde, Cameroon Postgrad. Med. J., November 1, 2002; 78(925): 678 - 681. [Abstract] [Full Text] [PDF]

				G. BARBARO, S. D FISHER, A. M PELLICELLI, and S. E LIPSHULTZ The expanding role of the cardiologist in the care of HIV infected patients Heart, October 1, 2001; 86(4): 365 - 367. [Full Text] [PDF]

				S. E. Lipshultz, K. A. Easley, E. J. Orav, S. Kaplan, T. J. Starc, J. T. Bricker, W. W. Lai, D. S. Moodie, G. Sopko, M. D. Schluchter, et al. Reliability of Multicenter Pediatric Echocardiographic Measurements of Left Ventricular Structure and Function: The Prospective P2C2 HIV Study Circulation, July 17, 2001; 104(3): 310 - 316. [Abstract] [Full Text] [PDF]

				G. Barbaro Cardiovascular manifestations of HIV infection J R Soc Med, January 8, 2001; 94(8): 384 - 390. [Full Text] [PDF]