Background: Antiretroviral therapy (ART) has reduced vertical transmission of HIV. However, long-term cardiotoxicity to children after in utero exposure to ART is unknown but has occurred in animals.
Methods: We compared echocardiograms taken between birth and 24 months in two groups of HIV-negative infants of HIV-positive mothers: one group of 136 infants who had been exposed to ART (ART+) and the other of 216 infants who had not (ART-).
Results: Mean left ventricular (LV) mass z-scores ranged from -0.09 to -1.42 below normal in both groups and were consistently lower in ART+ girls than in ART- girls: the differences in mean Z-scores were -0.40 at birth (P=0.01), -0.99 at 6 months (P<0.001), -0.73 at 12 months (P<0.001), and -0.86 at 24 months (P<0.001). Corresponding differences in Z-scores for boys were smaller: 0.13 at 1 month (P=0.41), -0.45 (P=0.01) at 6 months, -0.19 (P=0.24) at 12 months, and -0.32 at 24 months (P=0.05). Septal wall thickness and LV dimension were smaller than expected in ART+ infants, but LV contractility was consistently about 1 SD higher at all ages (P<0.001). In ART+ infants, LV fractional shortening was higher than in ART- infants: girls showed a greater difference.
Conclusion: Fetal exposure to ART is associated with reduced LV mass, LV dimension, and septal wall thickness Z-scores and increased LV fractional shortening and contractility during the first 2 years of life. These effects are more pronounced in girls than in boys. Fetal exposure to ART may impair myocardial growth while improving LV function.