Heart failure and cardiac disease in children with HIV infection

Cardiac complications in children infected with the human immunodeficiency virus (HIV) include heart failure, cardiomyopathy, arrhythmias, pericardial effusions and myocardial infarction. In addition, laboratory evidence of cardiac dysfunction has been associated with increased all-cause mortality in children with HIV. It is unclear whether heart disease is a marker for a more virulent course of illness or if there is a direct link between cardiac disease and increased mortality. Estimates of the incidence of cardiac dysfunction seen on echocardiography vary widely and have been described in up to 65% of children. The incidence of other cardiac complications also varies depending on surveillance and detection methods. More accurate estimates of the frequency and extent of heart disease in these children await completion of long-term studies currently in progress. Clinicians should maintain a high index of suspicion for heart disease in these children. Echocardiography is useful in the evaluation of cardiac function in HIV infected children and is recommended for those who are symptomatic from heart disease. Recognition of cardiac dysfunction is often difficult in these children because of the presence of complications such as fever, chronic lung disease, anemia, nephrotic syndrome and hepatosplenomegaly. Patients with pulmonary disease that is unresponsive to usual measures, or those with concurrent illnesses which may mask clinical signs of heart failure, should also be evaluated for cardiac disease.