Electrocardiography and 24-hour electrocardiographic ambulatory recording (Holter monitor) studies in children infected with human immunodeficiency virus type 1

Limited data are available on the electrocardiogram and ambulatory electroc ardiogram recording (Holter) in children infected with the human immunodefi ciency virus type 1 (HIV-1). The purpose of this study was to estimate the prevalence and cumulative incidence of rhythm and conduction abnormalities in HIV-1-infected children. Electrocardiograms and Holter monitoring studie s were performed annually on 205 HIV-1-infected children enrolled after 28 days of life (group I), 93 HIV-1-infected infants enrolled during pregnancy or during the first 28 days of life (group IIa), and 463 HIV-1-uninfected infants enrolled during pregnancy or during the first 28 days of life (grou p IIb). The 5-year cumulative incidence in the group I children of second-d egree atrioventricular block or supraventricular or ventricular tachycardia was 13.4%, and the 5-year incidence was higher for the older infected grou p I children (16.8% for children greater than or equal to 4 years old at fi rst study and 11.4% for children <4 years, p = 0.04). The mean corrected QT interval was also longer for the older infected group I children (p = 0.00 2) and prolonged in the HIV-1-infected compared to the HIV-1-uninfected gro up II children (p = 0.02). None of the children had atrial fibrillation or flutter. Arrhythmias are uncommon in children infected with HIV-1 and in ch ildren of HIV-1-infected mothers and the arrhythmias identified tend to be benign. Therefore, routine Holter monitoring does not appear to be indicate d in asymptomatic children. Few studies have dealt with the electrocardiographic and cardiac rhythm fin dings in pediatric patients infected with human immunodeficiency virus type 1 (HIV-1) [6, 7, 10, 11]. Electrocardiographic abnormalities, including vo ltage abnormalities, conduction defects, and dysrhythmias, have been report ed in 55% to 93% [6, 10] of children and 44% of adults [9] with HIV-1 infec tion. Prolongation of the QT interval has also been reported [8, 16]. The p urpose of this study was to estimate the prevalence and cumulative incidenc e of rhythm and conduction abnormalities in children infected with or expos ed in the perinatal period to HIV-1 and to determine the clinical importanc e of these abnormalities.