Left Ventricular Dysfunction Can Follow in Utero Exposure to Antiretroviral Therapy

By Reuters Staff

December 27, 2019

NEW YORK (Reuters Health) - Left ventricular diastolic dysfunction can follow in utero exposure to antiretroviral therapy (ART) in HIV-uninfected infants, according to findings from a longitudinal study.

Some ART agents appear to have adverse mitochondrial effects, and a recent study found echocardiographic evidence of adverse cardiac remodeling in fetuses of HIV-infected mothers exposed to combination ART.

Dr. Steven E. Lipshultz of the University at Buffalo Jacobs School of Medicine and Biomedical Sciences and Oishei Children's Hospital, in Buffalo, New York, and colleagues recently reported that perinatal exposure to highly active ART (HAART) is associated with reduced left ventricular (LV) mass, LV dimension and septal thickness, and increased LV fractional shortening and contractility at 2 years of age in children born to HIV-infected mothers.

In the current study, they compared a group of 148 HIV-uninfected infants who were exposed to ART in utero with a group of 130 healthy infants from the same era who were not exposed to either HIV or ART.

ART-exposed children had differences in echocardiographic LV diastolic indices at all ages, compared with healthy controls, indicating both impaired compliance and relaxation. These changes result in reduced cardiac efficiency.

Children exposed to ART also had lower early diastolic myocardial velocity, another indicator of LV relaxation, as well as an increasing myocardial performance index, consistent with abnormalities of global ventricular function, the team reports in AIDS.

In adults with heart disease, LV diastolic dysfunction frequently precedes LV systolic dysfunction, suggesting that lower LV diastolic function in these children coupled with other cardiovascular risk factors later in life could lead to worsening LV diastolic function and the onset of LV systolic dysfunction, the researchers note.

"Follow-up with serial echocardiograms is recommended in this population to further assess the potential cardiotoxic effects of perinatal exposure to ART," they conclude.

Dr. Lipshultz was unable to provide comments in time for publication.

SOURCE: https://bit.ly/2rb6XWR AIDS, online November 14, 2019.