Incidence and progression of echocardiographic abnormalities in HIV-infected older children and adolescents taking antiretroviral therapy: A prospective cohort study

Background A high prevalence of cardiac abnormalities has been reported in children with HIV taking ART in sub-Saharan Africa. We investigated the incidence and progression of cardiac abnormalities among children taking ART in Zimbabwe. Methods A prospective cohort study was conducted at a paediatric HIV clinic from 2014 to 2017. Children with HIV aged between 6 and 16 years and taking ART ≥6 months were enrolled. Transthoracic echocardiography was performed at baseline and 18 months. Results Of 197 participants recruited at baseline, 175 [(89%), 48% female, median age 12 (IQR, 10-14) years] were followed up. The incidence of left and right heart abnormalities was 3.52 and 5.64 per 100 pys, respectively. Stunting was associated with the development of any cardiac abnormality [adjusted OR 2.59 (95% CI, 1.03-6.49); p=0.043]. Right ventricular (RV) dilatation persisted at follow up in 92% and left ventricular (LV) diastolic dysfunction in 88%. Cardiac abnormalities present at baseline reverted to normal over the follow up period in 11(6%). There was an overall increase in mean z-scores for LV, left atrium (LA), RV, interventricular septum and LV posterior wall diameters at 18 months (p<0.001). Conclusions Despite ART, children with HIV have a high incidence of cardiac abnormalities, with only a minority being transient. Mean z-scores for LV, LA, RV, interventricular septum and LV posterior wall diameters increased over a relatively short follow up period, suggesting the potential for progression of cardiac abnormalities. Longer follow up is required to understand the clinical implications of these abnormalities.