Paediatrics Department, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa; Division of Paediatric Cardiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Pepeta, L., Paediatrics Department, Dora Nginza Hospital, Walter Sisulu University, Port Elizabeth, South Africa; Cilliers, A.M., Division of Paediatric Cardiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Objective To analyse the outcome of children with left ventricular dysfunction placed on Highly Active Antiretroviral Therapy. Method This study is a retrospective review of records of Human Immunodeficiency Virus-positive children with left ventricular dysfunction. Demographic data were collected. Left ventricular fractional shortening, CD4 percentage, viral load, and nutritional status were compared before and during antiretroviral therapy. Results We reviewed the records of 34 Human Immunodeficiency Virus-positive children with left ventricular dysfunction. In all, 18 patients received antiretroviral therapy (group one) and 16 were antiretroviral therapy naive (group two). The median age of group one at initial visit was 94 months, with a male-to-female ratio of 1:1. Of those, 17 children showed improved left ventricular function on treatment, with an increase in fractional shortening (median: 17-33.5%; p less than 0.0001). There was no significant statistical difference between the groups regarding initial fractional shortening. In group one, the CD4 percentage improved (median: 12% to 30.5%; p less than 0.0001), with viral load suppression (median: 24,900 copies per millilitre to less than 25 copies per millilitre; p less than 0.0001). There was weight gain in group one (median z-score: -1.70 to -1.32; p equal to 0.0083). Proper statistical analysis in group two was not possible because of poor follow-up of patients. Conclusion The findings are in keeping with other reports that have shown improvement in left ventricular function in patients with Human Immunodeficiency Virus-associated cardiomyopathy treated with Highly Active Antiretroviral Therapy. Recovery of myocardial function is associated with improvement in immunological and nutritional statuses. © Copyright 2012 Cambridge University Press.
abacavir; acetylsalicylic acid; antiretrovirus agent; carvedilol; didanosine; digitalis; digoxin; efavirenz; enalapril; furosemide; lamivudine; lopinavir plus ritonavir; potassium; spironolactone; stavudine; zidovudine; adolescent; article; cardiomyopathy; CD4 lymphocyte percentage; child; child health care; clinical article; clinical evaluation; controlled study; convalescence; demography; disease association; drug effect; drug safety; drug substitution; drug withdrawal; female; follow up; heart contraction; heart failure; heart left ventricle failure; highly active antiretroviral therapy; human; Human immunodeficiency virus infection; immune status; immunoreactivity; infant; lactic acidosis; male; medical record review; mitochondrial toxicity; nutritional status; outcome assessment; preschool child; school child; sex ratio; teaching hospital; treatment duration; virus load; weight gain; Adolescent; Antiretroviral Therapy, Highly Active; Child; Child, Preschool; Female; Follow-Up Studies; HIV Antibodies; HIV Infections; HIV-1; Hospitals, Teaching; Humans; Incidence; Male; Retrospective Studies; South Africa; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left