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Fetal Antiretroviral Exposure Impacts Cardiac Development

Antiretroviral exposure may impair myocardial growth, improve left ventricular function

THURSDAY, Dec. 23 (HealthDay News) -- Fetal exposure to antiretroviral therapy (ART) appears to be associated with increased left ventricular (LV) fractional shortening and contractility as well as reduced LV mass, septal thickness, and LV dimension, especially in girls, according to a study published in the Jan. 4 issue of the Journal of the American College of Cardiology.

In the National Heart, Lung, and Blood Institute Cardiovascular Status of HAART Therapy in HIV-Exposed Infants and Children Cohort Study, Steven E. Lipshultz, M.D., of the University of Miami Miller School of Medicine, and colleagues compared echocardiograms taken between birth and 24 months among 136 infants exposed to ART (ART+) and 216 not exposed to the treatment (ART−).

Compared to ART− girls, the investigators found that mean LV mass z-scores were consistently lower in ART+ girls. Differences in mean z-scores were −0.46 at birth (P = 0.005), −1.02 at six months (P < 0.001), −0.74 at 12 months (P < 0.001), and −0.79 at 24 months (P < 0.001). Among boys, the corresponding differences in z-scores were 0.13 at one month (P = 0.42), −0.44 at six months (P = 0.01), −0.15 at 12 months (P = 0.37), and −0.21 at 24 months (P = 0.21). While septal wall thickness and LV dimension were smaller than expected in ART+ infants, LV contractility was consistently about one standard deviation higher in all age groups. LV fractional shortening was higher among ART+ infants compared to ART− infants, with girls demonstrating a greater difference.

"Fetal exposure to ART is associated with reduced LV mass, LV dimension, and septal wall thickness z-scores and increased LV fractional shortening and contractility up to age 2 years. These effects are more pronounced in girls than in boys. Fetal ART exposure may impair myocardial growth while improving depressed LV function," the authors write.

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