Background: Antiretroviral therapy (ART) has greatly reduced vertical transmission of HIV. However, the long-term effects on left ventricular diastolic function in children after in utero exposure to ART and HIV have not been evaluated.
Methods: We compared Doppler indices of myocardial function from echocardiograms taken at birth through 48 months of age from 148 ART-exposed children enrolled in the Cardiac Status of Highly Active Antiretroviral Therapy (CHAART-1) study to those from 130 controls. Differences in diastolic measures between the two cohorts were analyzed using Generalized Estimating Equations models.
Results: Within the CHAART-1 cohort mitral valve (MV) early and late atrial velocities were below normal at all ages (p?0.001), MV E:A was above normal at 1,12 and 24-months of age (p=0.01, p<0.0001, p=0.0008) indicative of impaired compliance. Peak myocardial early diastolic velocity was below normal at all ages (p=0.01) consistent with impaired relaxation. The systolic ejection time was below normal at 1 month of age (p=0.001). The myocardial performance index was above normal at all ages (p<0.0001) indicative of impaired systolic and diastolic function.
Conclusion: HIV-uninfected children with fetal exposure to ART and HIV have statistically significant echocardiographic evidence of impaired left ventricular function during the first four years of life. We speculate that fetal ART and HIV exposure may impact myocardial growth and subsequently affect myocardial contractility and relaxation. This effect may be modulated by age and gender. Follow-up of left ventricular function in this group appears warranted.