Cardiac Manifestations in HIV Infected Children. Are they under Diagnosed?

Abstract

Background: The aim of this study was to evaluate cardiac manifestations in HIV-infected children in India.
Methods & Results: This was a cross sectional study in HIV positive children up to 18 years of age, at a pediatric HIV clinic of a tertiary care teaching hospital in Maharashtra, India. All children were thoroughly evaluated by detailed history, clinical examination and underwent chest radiograph, Electrocardiograph (ECG) and Echocardiography (Echo). Of the 119 children who completed the study, the male to female ratio was 1.16:1 and the mean age was 8.9 years (range 2-17 years). Cardiovascular abnormalities were detected in 74 (62%) children on echo and /or ECG. Echocardiography alone was abnormal in 44 (36.9%) children and ECG alone was abnormal in 56 (47%) children. However, only 11(9%) children were found to be symptomatic with cardiovascular symptoms. The prevalence of Congenital Heart Disease (CHD) was 4%. The most common ECG abnormality observed in the study was sinus tachycardia in 35 (29%) followed by ST-T changes in 20 (16.8%). The most common echocardiographic abnormality encountered was LV systolic dysfunction seen in 31 (26%) cases, followed by Low LV ejection fraction in 24 (20%) cases. Children with abnormal echo and ECG were in higher WHO clinical and immunological stages (III & IV), however the association between the two was not found to be statistically significant.

Conclusions: This study establishes that subclinical cardiac manifestations are prevalent in HIV infected children. More research should be done on the clinical significance of these findings and the need for long-term follow up.