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CLINICAL STUDIES

Prevalence of congenital cardiovascular malformations in children of human immunodeficiency virus-infected women

The prospective P²C² HIV multicenter study

Wyman W. Lai, MD, MPH, FACC^*, Steven E. Lipshultz, MD ^,1, Kirk A. Easley, MS, Thomas J. Starc, MD^||, Stacey E. Drant, MD^¶, J. Timothy Bricker, MD, FACC^#, Steven D. Colan, MD, FACC , Douglas S. Moodie, MD, FACC, George Sopko, MD, MPH^**, Samuel Kaplan, MD, FACC^¶ for the P2C2 HIV Study Group National Heart Lung and Blood Institute Bethesda Maryland

^* Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai School of Medicine, New York, New York, USA
Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Biostatistics and Epidemiology, Division of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Pediatrics, Division of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
^|| Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University School of Medicine, New York, New York, USA
^¶ Department of Pediatrics, Division of Pediatric Cardiology, University of California, Los Angeles School of Medicine, Los Angeles, California, USA
^# Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas, USA
^** Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA

Manuscript received December 18, 1997; revised manuscript received July 8, 1998, accepted July 29, 1998.

Address for correspondence: Dr. Wyman W. Lai, Division of Pediatric Cardiology, Box 1201, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York 10029-6574
Wyman_Lai{at}smtplink.mssm.edu

Objectives. The purpose of the study was to assess the effects of maternal HIV-1 (human immunodeficiency virus) infection and vertically transmitted HIV-1 infection on the prevalence of congenital cardiovascular malformations in children.

Background. In the United States, an estimated 7000 children are born to HIV-infected women annually. Previous limited reports have suggested an increase in the prevalence of congenital cardiovascular malformations in vertically transmitted HIV-infected children.

Methods. In a prospective longitudinal multicenter study, diagnostic echocardiograms were performed at 4–6-month intervals on two cohorts of children exposed to maternal HIV-1 infection: 1) a Neonatal Cohort of 90 HIV-infected, 449 HIV-uninfected and 19 HIV-indeterminate children; and 2) an Older HIV-Infected Cohort of 201 children with vertically transmitted HIV-1 infection recruited after 28 days of age.

Results. In the Neonatal Cohort, 36 lesions were seen in 36 patients, yielding an overall congenital cardiovascular malformation prevalence of 6.5% (36/558), with a 8.9% (8/90) prevalence in HIV-infected children and a 5.6% (25/449) prevalence in HIV-uninfected children. Two children (2/558, 0.4%) had cyanotic lesions. In the Older HIV-Infected Cohort, there was a congenital cardiovascular malformation prevalence of 7.5% (15/201). The distribution of lesions did not differ significantly between the groups.

Conclusions. There was no statistically significant difference in congenital cardiovascular malformation prevalence in HIV-infected versus HIV-uninfected children born to HIV-infected women. With the use of early screening echocardiography, rates of congenital cardiovascular malformations in both the HIV-infected and HIV-uninfected children were five- to ten-fold higher than rates reported in population-based epidemiologic studies but not higher than in normal populations similarly screened. Potentially important subclinical congenital cardiovascular malformations were detected.

Abbreviations and Acronyms   HIV = human immunodeficiency virus   P2C2 = pediatric pulmonary and cardiac complications

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