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Cardiovascular Complications in HIV-Infected Children

  • D. Bonnet

Abstract

Longitudinal cardiovascular follow-up of HIV-infected children has shown that all components of the cardiovascular system might be affected during the course of the disease. The most frequent feature observed in the pediatric population is left ventricular dysfunction [1–12]. In developed countries, antiviral therapy has dramatically improved morbidity and mortality in HIV-infected children. Consequently, the spectrum of HIV-related concerns has shifted from reduction of mortality towards longer-term complications of HIV infection and adverse effects associated with the use of antiretroviral therapy. With regards to the cardiovascular system, efforts have been made to describe the long-term outcome in children. In this chapter, we review the different cardiac diseases that occur in HIV-infected children. HIV-related cardiac complications are very similar to the spectrum of disease described in adults, with a few exceptions. There have been descriptions of fetal and neonatal complications due to the common vertical transmission of the virus in most cases and the possible adverse intrauterine effects of maternal HIV infection with or without fetal HIV infection [12, 13]. The pathogenesis of some cardiac manifestations remains uncertain. Although in some cases the myocardial [14], endocardial [15], or pericardial disease [16, 17] may be attributed to an opportunistic infection, it is likely that HIV-related cardiac disease has a multifactorial origin due to HIV, secondary infections, other concurrent disease states, side effects of therapy, nutritional deficiencies, or yetunknown mechanisms. However, it is recommended that children with active HIV infection should be monitored for cardiac disease because symptoms of cardiac failure are delayed and interventions might be required to reduce cardiac morbidity and mortality. Finally, the long-term “vascular” outcome might be impaired either by the HIV infection or by the metabolic effects of the antiretroviral therapy or their synergistic effect on endothelium. Early atherosclerosis may be a new emerging disease in HIV-infected children, and this raises concern on the prevention of vascular damage.

Keywords

Human Immunodeficiency Virus Human Immunodeficiency Virus Type Pericardial Effusion Acquire Immunodeficiency Syndrome Classic Cardiovascular Risk Factor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • D. Bonnet
    • 1
  1. 1.Service de Cardiologie PédiatriqueHôpital Necker-Enfants MaladesParisFrance

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