[Cardiac longitudinal study of children perinatally exposed to human immunodeficiency virus type 1].

OBJECTIVE

To determine the frequency of cardiac abnormalities and its natural history in children perinatally exposed to HIV-1.

METHODS

Eighty-four children exposed to HIV-1 were evaluated by serial clinical, electrocardiographic (ECG), and Doppler-echocardiographic (ECHO) examinations.

RESULTS

Group I--(seroreversion)--43 children (51.2%). Absence of clinical abnormalities. ECG: incomplete right bundle branch block (RBBB) 5 cases. ECHO: atrial septal defect (ASD) and ventricular septal defect (VSD)--1 case each. Group II--41 HIV-infected children (48.8%), of whom 51.2% were found to have cardiac abnormalities. Asymptomatic or mildly symptomatic children without immunosuppression: no clinical and echocardiographic abnormalities; ECG: incomplete right bundle branch block (RBBB)--(2 cases). Children with moderate and severe symptoms and immunological impairment: the following abnormalities were found: 1) clinical (31.7%)-isolated tachycardia (1 case), congestive heart failure (12 cases). 2) electrocardiographic (43.9%)- sinus tachycardia associated with other abnormalities (10 cases), incomplete right bundle branch block (5 cases), left anterior hemiblock (1 case), right anterior hemiblock (1 case), changes in ventricular repolarization (11 cases), right ventricular overload (2 cases), left ventricular overload (1 case), right QRS axis deviation (1 case), and arrhythmias (3 cases). 3) echocardiographic (26.8%)- dilated cardiomyopathy (5 cases), pericardial effusion with tamponade (2 cases), pulmonary hypertension (2 cases), and mitral valve prolapse (1 case).

CONCLUSION

Cardiac involvement was a characteristic of the HIV-infected group. Higher prevalence of abnormalities was found among children belonging to the most advanced clinical and immunological category. The most commonly observed clinical, electrocardiographic and echocardiographic findings were congestive heart failure (CHF), changes in ventricular repolarization, and dilated cardiomyopathy, respectively. The latter was reversible in one case. Electrocardiogram changes were significantly more frequent than clinical and echocardiographic changes.