Impact of Highly Active Anti-Retroviral Therapy on Paediatric Human Immuno-deficiency Virus Associated Left Ventricular Dysfunction within the Johannesburg Teaching Hospital Complex

  • Dr Lungile Pepeta, Nelson Mandela Academic Hospital, Walter Sisulu University, South Africa
  • Prof Antoinette Cilliers, University of Witwatersrand, South Africa
  • Dr Willy Hendson, University of Witwatersrand, South Africa
  • Dr Deliwe Ngwezi, University of Witwatersrand, South Africa
  • Dr Firoza Motara, University of Witwatersrand, South Africa
  • Dr Paul Adams, University of Witwatersrand, South Africa
  • Dr Hopewell Ntsinjana, University of Witwatersrand, South Africa

    • OBJECTIVE
    To analyze the outcome of paediatric patients with left ventricular (LV) dysfunction placed on Highly Active Anti-Retroviral Therapy (HAART).

    METHOD
    Retrospective review of records of HIV positive children with LV dysfunction managed at Johannesburg Teaching Hospital Complex. Baseline characteristics were documented. The following variables: fractional shortening (FS), CD4 percentage, viral load and nutritional status were compared before and after commencement HAART..

    RESULTS
    Thirty four patients with LV dysfunction had their records reviewed.
    Eighteen patients with LV dysfunction (group 1) received HAART, and 16 (group 2) were HAART naïve (pre HAART era). The mean age of group 1 patients at initial visit was 75 months, with a M:F ratio of 9:9. Seventeen patients showed improved LV function, from a mean FS of 18% to 32.8%,(p-value <0.0001). There was an increase in CD4 percentage from a median of 12% to 30.5% (p value <0.0001). There was viral load suppression from an initial median viral copies of 24 900 to < 25 copies (p value <0.0001). There was weight gain following HAART from a median z-score of -1.70 pre-HAART to -1.32 during HAART (p value = 0.0083). There was no statistically significant difference between group 1 and group 2 regarding FS and nutritional z-scores at the initial visit.

    CONCLUSION
    The findings are in keeping with other reports that have shown improvement in left ventricular function in patients with HIV associated cardiomyopathy treated with HAART. The recovery of myocardial function is associated with improvement of their initially poor immunological and nutritional status.