Echocardiography and carotid intima-media thickness among asymptomatic HIV-infected adolescents in Thailand.

Before the availability of highly active antiretroviral therapy (HAART), cardiovascular diseases (CVD) were commonly found in adult HIV-infected patients with advanced HIV disease.[1–3] However, the risk of CVD has remained despite the existence of HAART. Among HIV-infected children aged 18 months to 12 years with no prior cardiac problems in a tertiary teaching hospital in Nigeria, although 84% were receiving HAART, 33.7% were found to have dilated cardiomyopathy and 14.5% had pericardial effusion ≥ 5.0 mm.[4] The US National Institutes of Health (NIH) Multicenter Pediatric HIV/AIDS Cohort Study (PHACS) found that among children receiving long-term HAART, 10% had an extreme left ventricle (LV) dimension, increased aortic valve area or diameter, or a reduction of left ventricular ejection fraction (LVEF).[5] Children with HIV infection had increased carotid intima-media thickness (cIMT) compared to normal children.[6–8] Increased cIMT is a marker of CVD risk in the adult population.[9–10] These cardiovascular risks have not been studied in children and adolescents in Asia. Moreover, the long-term outcome of CVD in children and adolescents receiving HAART is unknown. Some pro-inflammatory cytokines such as monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 have been found to be higher in HIV-infected children compared to normal children[11] and high-sensitivity C-reactive protein (hs-CRP) has been found to be associated with increased cIMT.[12] These findings suggest that chronic inflammation and vasculopathy were the likely causes of CVD in HIV infection and these cytokines may be predictive of CVD. Recently, the N-terminal pro brain natriuretic peptide (NT-pro-BNP), a hormone released from the heart, has been widely used to assess the severity of left ventricular dysfunction, heart failure, and acute coronary syndromes.[13–15] However, NT-pro-BNP has not been studied in cardiovascular assessment in any HIV-infected patients. Most of the cardiac abnormalities detected by studies using echocardiography in HIV-infected children were often asymptomatic.[16–17] Echocardiography has been the standard method to assess cardiovascular structure, but generally has been of limited accessibility in resource-limited settings. Therefore, CVD or abnormal cardiac conditions in asymptomatic patients have been largely unrecognized and underreported. Evaluating CVD by echocardiography and associated risks in HIV-infected children is, however, useful for early detection of cardiovascular abnormalities. In this study, we evaluated the cardiovascular conditions and cIMT by echocardiography in perinatally HIV-infected adolescents who had no apparent cardiovascular problems and were receiving HAART, and compared their results with those of age-matched healthy controls. We also evaluated risk factors and biomarkers associated with cardiovascular abnormalities.