Prenatal HIV-ART Exposure May Contribute to Cardiac Changes in Babies

By Reuters Staff

February 02, 2021

NEW YORK (Reuters Health) - HIV uninfected infants exposed to antiretroviral therapy (ART) before birth may have "relevant" cardiovascular changes, report clinicians in Spain.

"Subclinical cardiac impairment together with higher blood pressure and thicker carotid intima media thickness (cIMT) were observed in HIV-exposed infants at six months of age. Half of them presented hypertension," report Dr. Marta Lopez and colleagues from the University of Barcelona.

"Our findings support a possible increased cardiovascular risk in HIV uninfected infants exposed in utero to ART," they write in Clinical Infectious Diseases.

The researchers followed 34 HIV-exposed uninfected infants and 53 non-HIV-exposed infants up to age 6 months. ART regimens during pregnancy included two nucleoside reverse transcriptase inhibitors (abacavir plus lamivudine, 32%; emtricitabine plus tenofovir, 41%; and zidovudine plus lamivudine, 21%).

At age 6 months, HIV-exposed uninfected infants had thicker myocardial walls (septal wall thickness mean, 5.02 vs. 3.98 mm; P<0.001) and relative systolic dysfunction with decreased mitral-ring displacement (8.57 vs. 10.34 mm, P=0.002) and decreased tricuspid S' (9.71 vs. 11.54 cm/s, P=0.003) together with relative diastolic dysfunction indicated by prolonged left isovolumic relaxation time (58.57 vs. 47.94 ms, P<0.001).

Vascular assessment revealed significantly higher systolic (102 vs. 80 mmHg, P<0.001) and diastolic (64 vs. 55 mmHg, P=0.045) blood pressures. Half of the HIV-exposed children met criteria for hypertension compared with 3.77% of the non-HIV-exposed group (P<0.001).

The HIV-exposed children also had thicker mean cIMT (0.62 vs. 0.51 um; P=0.015).

"These changes could allow us to target them as a population at risk even from fetal life, establishing a strict and longer follow-up," the authors say.

"Interestingly, our study shows for the first time, that infant hypertension could be predicted from fetal life by assessing maternal ART regimens containing zidovudine and/or by measuring fetal septal wall thickness by fetal echocardiography," they add.

The researchers say their findings also "support the current trend of considering zidovudine-containing ART regimens during pregnancy as alternative due to complex dosing and association with higher rates of mild-to-moderate adverse effects. Avoiding ART regimens containing zidovudine during pregnancy, promoting healthy lifestyle habits and avoiding other cardiovascular risks from the childhood, could potentially prevent cardiovascular events later in life."

The study had no commercial funding and the authors have no relevant disclosures. Dr. Lopez did not respond to a request for comment by press time.

SOURCE: Clinical Infectious Diseases, online January 20, 2021.