International AIDS Society

Maternal Abacavir, Smoking Tied to Heart Markers in HIV-Exposed Kids

Author: Mark Mascolini

06 May 2013

HIV-exposed but uninfected (HEU) children of HIV-positive mothers who took abacavir, smoked, or drank alcohol had elevated levels of cardiac biomarkers that could signal heart trouble, according to analysis of the US Pediatric HIVAIDS Cohort Study (PHACS). The study also linked cardiac biomarkers to some echocardiographic abnormalities.

To identify possible associations between cardiac biomarkers and in utero antiretroviral exposure—as well as maternal characteristics—PHACS investigators studied 338 HEU children averaging 4.3 years in age. Half (51%) had elevated levels of one or more cardiac biomarkers. The biomarkers were cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hsCRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP).

Maternal abacavir use more than doubled chances of elevated cTnT (adjusted odds ratio [aOR] 2.33, P = 0.04), and maternal alcohol use more than tripled chances of high cTnT (aoR 3.56, P = 0.01). Maternal tobacco use more the doubled the odds of high NT-proBNP (aOR 2.28, P = 0.02).

Ninety-four children had paired echocardiogram-biomarker measurements. cTnT measurements correlated with increased left-ventricular thickness-to-dimension ratio (r  =  0.21, P  =  0.04). Elevated cTnT correlated with higher mean left-ventricular end-diastolic (LVED) posterior wall thickness (P  =  0.04).

hsCRP negatively correlated with septal wall thickness (r = –0.22, P = 0.03). Elevated hsCRP was associated with lower mean left-ventricular contractility z scores (P = 0.04).

NT-proBNP measurements correlated with increased LVED dimension (r  =  0.20, P  =  0.05). Elevated NT-proBNP was associated with lower mean end-systolic septal thickness (P =  0.03).

PHACS investigators believe their findings “suggest that cardiac biomarkers may help identify HEU children who require further cardiac evaluation including echocardiography.” They call for further study of “potential cardiac effects of prenatal abacavir exposure in this population.”

Source: James D. Wilkinson, Paige L. Williams, Erin Leister, Bret Zeldow, William T. Shearer, Steven D. Colan, George K. Siberry, Laurie B. Dooley, Gwendolyn B. Scott, Kenneth C. Rich, Steven E. Lipshultz, for the Pediatric HIVAIDS Cohort Study (PHACS). Cardiac biomarkers in HIV-exposed uninfected children. AIDS. 2013; 27: 1099-1108.

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