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CLINICAL RESEARCH

Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome

Inas Al-Attar, MD^*, E. John Orav, PhD^||, Vernat Exil, MD, Sarah A. Vlach, MD^*¶ and Steven E. Lipshultz, MD^*¶#,*

^* Department of Cardiology, Boston, Massachusetts, USA
Division of Infectious Diseases, Children’s Hospital USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
^|| Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
^¶ Division of Pediatric Cardiology, Golisano Children’s Hospital at Strong and University of Rochester Medical Center, Rochester, New York, USA
^# Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA

Manuscript received December 26, 2002; accepted January 16, 2003.

^* Reprint requests and correspondence: Dr. Steven E. Lipshultz, Division of Pediatric Cardiology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 631, Rochester, New York, USA 14642.
steve_lipshultz{at}urmc.rochester.edu

OBJECTIVES: The aim of this study was to determine the prevalence of cardiovascular dysfunction and its predictors in children with acquired immunodeficiency syndrome (AIDS).

BACKGROUND: Cardiovascular manifestations are common among children with AIDS but may be clinically occult.

METHODS: We reviewed the medical records, echocardiograms, electrocardiograms, and Holter monitor studies of 68 children with AIDS. We tested clinical and demographic characteristics at the time of AIDS diagnosis for their ability to predict serious cardiac events, death, and cardiac death.

RESULTS: The median time from AIDS diagnosis to death or end of follow-up was 1.0 year (range, 1 week to 7.9 years). Nineteen patients (28%) experienced serious cardiac events after AIDS diagnosis. Of 43 patients who died, 15 (35%) had cardiac dysfunction. Multivariable analyses revealed that recurrent bacterial infections, wasting, encephalopathy, male gender, and an earlier year of AIDS diagnosis were predictors of serious cardiac events (relative risk [RR] = 9.3, 6.9, 4.7, 4.1, and 0.76, respectively, p < 0.05). Wasting, encephalopathy, a low age-adjusted CD4 count, a low age-adjusted immunoglobulin G (IgG) level, and an earlier year of AIDS diagnosis increased the risk of all-cause mortality (RR = 8.9, 5.1, 2.7, 0.82, and 0.8, respectively, p 0.02). Male gender, a low age-adjusted CD4 count, and a low age-adjusted IgG level increased the risk for cardiac death (RR = 16.9, 4.2, and 0.68, respectively, p 0.05).

CONCLUSIONS: Serious cardiac events and cardiac death are common among children with AIDS. Factors such as recurrent bacterial infections, wasting, encephalopathy, male gender, low CD4 and IgG levels, and an earlier year at AIDS diagnosis may identify high-risk patients.

Abbreviations and Acronyms   AIDS = acquired immunodeficiency syndrome   CDC = Centers for Disease Control and Prevention   CMV = cytomegalovirus   DDC = dideoxycytosine   DDI = dideoxyinosine   EBV = Epstein-Barr virus   ECG = electrocardiogram   HIV = human immunodeficiency virus   IgG = immunoglobulin G   IgM = immunoglobulin M   LIP = lymphoid interstitial pneumonitis   RR = relative risk   ZDV = zidovudine

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