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JACC:围产期HIV感染儿童:暴露于HAART心脏结构和功能更好

2017-12-28 闫盈盈 环球医学

当下,通过高活性抗逆转录病毒疗法(HAART)使得艾滋病患者的生存率大幅提高。2017年发表在《J Am Coll Cardiol》上的一项研究,对引入HAART在HIV感染的儿童中的长期心血管影响进行了评估。

当下,通过高活性抗逆转录病毒疗法(HAART)使得艾滋病患者的生存率大幅提高。2017年发表在《J Am Coll Cardiol》上的一项研究,对引入HAART在HIV感染儿童中的长期心血管影响进行了评估。

背景:在引入HAART之前,心源性死亡和发病在HIV感染儿童中常见。

目的:旨在识别HAART在HIV感染的儿童中的长期心血管影响。

方法:CHAART-2(HIV感染儿童的HAART相关心脏毒性)研究将垂直传播HIV感染的肺和心脏并发症(P2C2 HIV)研究中的74例HAART暴露儿童的148个超声心动图和140例HAART未暴露但HIV感染儿童的860个超声心电图进行了前瞻性比较。两项研究都使用了相似的方案,集中判读超声心电图,以参照健康对照的z评分表达测量。HAART暴露和超声心电图测量之间的相关性使用广义估计方程进行评估。

结果:将HAART暴露和HAART未暴露组进行比较时,所有HAART暴露都与左心室(LV)缩短分数(差异的z评分,1.07;P=0.02)和HAART暴露时间(每年差异的z评分,0.17;P=0.003)正相关。LV质量与HAART暴露(差异的z评分,-0.64;P=0.01)和室间隔厚度(差异的z评分,-0.93;P=0.001)负相关。HAART暴露时间与LV收缩末期体积和心率负相关(每年差异的z评分,-0.11和-0.10;P=0.05和0.002)。11年的随访期,与HAART未暴露组相比,HAART暴露组的LV质量和LV舒张末期室间隔厚度都降低,而LV收缩功能和LV缩短分数升高。

结论:暴露于HAART的围产期HIV感染儿童的心脏结构和功能,比在HAART出现之前时代中相同疾病儿童的更好,但会随着时间衰减。需要心血管监测的偱证策略来支持治疗决策,从而改善长期心血管健康。

原始出处:
Lipshultz SE, Wilkinson JD, Thompson B,et al.Cardiac Effects of Highly Active Antiretroviral Therapy in Perinatally HIV-Infected Children: The CHAART-2 Study.J Am Coll Cardiol. 2017;70(18):2240-2247. doi: 10.1016/j.jacc.2017.09.008.

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    2018-03-02 hbwxf
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    2018-01-02 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2018-01-02 stupidox

    学习了.谢谢分享

    0

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    2017-12-31 jyzxjiangqin

    围产期HIV感染儿童.

    0

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    2017-12-30 zhaojie88
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    2017-12-29 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

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    2017-12-28 杨利洪

    学习了分享了

    0

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