June 9, 1993

Cardiac Morbidity and Related Mortality in Children With HIV Infection

Author Affiliations

From the Division of Infectious Disease (Drs Luginbuhl and McIntosh) and Department of Cardiology (Dr Lipshultz), Children's Hospital; Department of Biostatistics, Harvard School of Public Health (Dr Orav); Department of Pediatrics, Harvard Medical School (Drs Luginbuhl, McIntosh, and Lipshultz); and Department of Medicine, Brigham and Women's Hospital (Dr Orav), Boston, Mass.

JAMA. 1993;269(22):2869-2875. doi:10.1001/jama.1993.03500220055026

Objective.  —Dysrhythmias, hemodynamic instability, congestive heart failure, and sudden death are serious complications of human immunodeficiency virus (HIV) infection that, to our knowledge, have not been studied systematically. We sought to determine the cumulative incidence and clinical predictors of these adverse events in a cohort of HIV-infected children.

Design.  —Historical cohort study.

Setting.  —University-affiliated, primary and tertiary care pediatric hospital and ambulatory care center.

Participants.  —Eighty-one HIV-infected children who had one or more cardiac evaluations between 1984 and 1991 form the study cohort. The initial cardiac evaluation occurred at a median age of 1.5 years, and children were followed up to a median age of 3.6 years.

Main Outcome Measures.  —Mortality (related to cardiac dysfunction as well as noncardiac causes), tachycardia, bradycardia, hypertension, hypotension, marked sinus arrhythmia, cardiac arrest, and chronic congestive heart failure.

Results.  —Hemodynamic abnormalities and dysrhythmias occurred frequently. Eight unexpected cardiorespiratory arrests occurred in seven children (9%). Chronic congestive heart failure was noted in 10% of patients. Thirty children died, 10 with significant cardiac dysfunction. As HIV-infected children progressed from acquired immunodeficiency syndrome (AIDS)—related complex to AIDS, significant cardiac problems were more likely to occur. Both nonneurologic AIDS and encephalopathy were strongly associated with most severe cardiac outcomes. However, encephalopathy was the strongest correlate of cardiorespiratory arrest (P=.002). Epstein-Barr virus coinfection was the strongest correlate of chronic congestive heart failure (P<.001).

Conclusions.  —Cardiac morbidity and mortality are more common with advanced HIV infection. The presence of encephalopathy or Epstein-Barr virus coinfection identifies HIV-infected children at especially high risk for adverse cardiac outcomes.(JAMA. 1993;269:2869-2875)