YOU ARE HERE:
HIV infection and treatment linked to heart disease in children
Children infected with HIV show early signs of cardiovascular disease, particularly if they have been treated with protease inhibitors, according to the results of a study presented in the 5th July edition of Circulation. This suggests that children with HIV may be at an elevated risk of heart attack or stroke during adolescence or early adulthood.
HIV infection and treatment with anti-HIV drugs are known to be risk factors for the development of cardiovascular disease in adults, resulting in an increased incidence of premature cardiovascular events like heart attacks or strokes. However, fewer data are available on the risk of cardiovascular disease faced by HIV-positive children.
To assess this risk, investigators from Great Ormond Street Hospital in London studied 83 children aged between five and 18 years who had been infected with HIV via mother-to-child transmission. The researchers measured the structure and function of their blood vessels, comparing them to measurements from a group of 59 HIV-negative children.
“Structural and functional changes of the vasculature are already present during childhood in HIV-infected children,” they write. “These changes were most pronounced in children receiving protease inhibitors but were also observed in non-protease inhibitor-treated and untreated children.
“Our findings support a role for both HIV infection itself and antiretroviral therapy, particularly protease inhibitors, in the pathogenesis of early vascular disease,” they conclude.
The HIV-positive children had greater carotid intima-media thickness (IMT) than the HIV-negative controls (mean 0.6 vs. 0.47mm; p < 0.001). IMT is a reliable marker of damage to blood vessels that can be measured with an ultrasound scan of the neck. Higher IMT values indicate a thickening of the inner wall of the artery and are predictive of the development of cardiovascular disease.
The investigators also found that both age and HIV treatment were associated with IMT in the HIV-positive children. Since all of the children were infected through mother-to-child transmission, age is an approximate marker of the duration of infection in this group, suggesting that both HIV infection and treatment are linked to blood vessel damage.
The 31 children who had received protease inhibitors had a greater IMT than the 25 who had received anti-HIV treatment that did not contain protease inhibitors (p = 0.04) and the 27 who had received no treatment (p = 0.01). However, IMT was not linked to CD4 cell percentage or viral load.
The investigators also measured the flexibility of the children’s blood vessels using flow-mediated dilatation (FMD) with ultrasound scans of an artery in the arm. They found that FMD was significantly reduced in the HIV-positive children (7.9 vs. 9.4%; p = 0.02), and that the children who had been treated with protease inhibitors showed lower FMD scores than those who had received protease inhibitor-sparing treatment (p = 0.05) and those who had never been treated (p < 0.001).
The HIV-positive children also had raised levels of triglycerides, non-high density lipoprotein (HDL) cholesterol, apolipoprotein B and lipoprotein (a). The children who had taken anti-HIV therapy, particularly those with experience of protease inhibitor-based treatment, had higher levels.
“Because death rates among HIV-infected children have decreased fivefold since the introduction of the highly active antiretroviral treatment, careful long-term monitoring appears warranted to detect emerging cardiovascular disease,” the researchers conclude.
However, they admit that their results require confirmation in studies that follow children over time, in order to understand the separate contributions of HIV and its treatment more fully.
“Longitudinal studies are required to differentiate the relative impact of HIV disease and antiretroviral therapy and to assess the potential for prevention,” they write.
Reference
Charakida M et al. Early structural and functional changes of the vasculature in HIV-infected children. Impact of disease and antiretroviral therapy. Circulation 112: 103-109, 2005.
HIV infection and treatment with anti-HIV drugs are known to be risk factors for the development of cardiovascular disease in adults, resulting in an increased incidence of premature cardiovascular events like heart attacks or strokes. However, fewer data are available on the risk of cardiovascular disease faced by HIV-positive children.
To assess this risk, investigators from Great Ormond Street Hospital in London studied 83 children aged between five and 18 years who had been infected with HIV via mother-to-child transmission. The researchers measured the structure and function of their blood vessels, comparing them to measurements from a group of 59 HIV-negative children.
“Structural and functional changes of the vasculature are already present during childhood in HIV-infected children,” they write. “These changes were most pronounced in children receiving protease inhibitors but were also observed in non-protease inhibitor-treated and untreated children.
“Our findings support a role for both HIV infection itself and antiretroviral therapy, particularly protease inhibitors, in the pathogenesis of early vascular disease,” they conclude.
The HIV-positive children had greater carotid intima-media thickness (IMT) than the HIV-negative controls (mean 0.6 vs. 0.47mm; p < 0.001). IMT is a reliable marker of damage to blood vessels that can be measured with an ultrasound scan of the neck. Higher IMT values indicate a thickening of the inner wall of the artery and are predictive of the development of cardiovascular disease.
The investigators also found that both age and HIV treatment were associated with IMT in the HIV-positive children. Since all of the children were infected through mother-to-child transmission, age is an approximate marker of the duration of infection in this group, suggesting that both HIV infection and treatment are linked to blood vessel damage.
The 31 children who had received protease inhibitors had a greater IMT than the 25 who had received anti-HIV treatment that did not contain protease inhibitors (p = 0.04) and the 27 who had received no treatment (p = 0.01). However, IMT was not linked to CD4 cell percentage or viral load.
The investigators also measured the flexibility of the children’s blood vessels using flow-mediated dilatation (FMD) with ultrasound scans of an artery in the arm. They found that FMD was significantly reduced in the HIV-positive children (7.9 vs. 9.4%; p = 0.02), and that the children who had been treated with protease inhibitors showed lower FMD scores than those who had received protease inhibitor-sparing treatment (p = 0.05) and those who had never been treated (p < 0.001).
The HIV-positive children also had raised levels of triglycerides, non-high density lipoprotein (HDL) cholesterol, apolipoprotein B and lipoprotein (a). The children who had taken anti-HIV therapy, particularly those with experience of protease inhibitor-based treatment, had higher levels.
“Because death rates among HIV-infected children have decreased fivefold since the introduction of the highly active antiretroviral treatment, careful long-term monitoring appears warranted to detect emerging cardiovascular disease,” the researchers conclude.
However, they admit that their results require confirmation in studies that follow children over time, in order to understand the separate contributions of HIV and its treatment more fully.
“Longitudinal studies are required to differentiate the relative impact of HIV disease and antiretroviral therapy and to assess the potential for prevention,” they write.
Reference
Charakida M et al. Early structural and functional changes of the vasculature in HIV-infected children. Impact of disease and antiretroviral therapy. Circulation 112: 103-109, 2005.
aidsmap resources
- Cardiovascular risk increased in majority of PI studies, systematic review shows
- Cardiovascular risks of HAART: More data but little more clarity?
- Children and HIV
- Developed world
- Heart disease and antiretroviral therapy
- Lipodystrophy
- Protease inhibitors associated with increased risk of cardiovascular disease
- Risk factors for heart disease widespread among HIV patients
- Side-effects
- Silent heart disease found in 10% of HIV patients
- Statistics and epidemiology
- Studies provide more information on HIV, HAART and heart disease
- Traditional risk factors, not PIs or HIV cause hardening of arteries in US study
- 'Weight of evidence' suggests that HAART increases the risk of heart disease, says NEJM editorial
- Younger HIV patients at increased risk of heart disease
Children and HIV news
- Updated British HIV pregnancy guidelines published
- Infants starting HIV treatment less likely to completely suppress viral load
- HIV treatment effective for infants in resource-limited settings
Developed world news
- Justice Edwin Cameron calls for a campaign against 'misguided criminal laws and prosecutions'
- Immigration and prevention: the effect of migration on risk behaviour
- One in five patients at London clinic are lost to follow-up and do not attend elsewhere in the UK
Lipodystrophy news
- Low CD4 cell count, but not HIV treatment, increases risk of hardening of the arteries
- Long-term HIV treatment cuts risk of hardening of coronary artery
- Switch to atazanavir does not reduce belly fat
Side-effects news
- Low CD4 cell count, but not HIV treatment, increases risk of hardening of the arteries
- Long-term HIV treatment cuts risk of hardening of coronary artery
- Heat-stable ritonavir tablet equivalent to soft gel capsule; may be approved next year