Dilation of the aortic root in children infected with human immunodeficiency virus type 1: The Prospective (PCHIV)-C-2-H-2 Multicenter Study

Background Vascular lesions have become more evident in human immunodeficie ncy virus type 1 (HIV)-infected patients as the result of earlier diagnosis , improved treatment, and longer survival. Aortic root dilation in HIV-infe cted children has not previously been described. This study was undertaken to determine the prevalence of aortic root dilation in HIV-infected childre n and to evaluate some of the potential pathogenic mechanisms. Methods Aortic root measurements were incorporated into the routine echocar diographic surveillance of 280 children of HIV-infected women: an older coh ort of 86 HIV-infected children and a neonatal cohort of 50 HIV-infected an d 144 HIV-uninfected children. Results By repeated-measures analyses, mean aortic root measurements were s ignificantly increased in HIV-infected children versus HIV-uninfected child ren (P values of less than or equal to .04 and less than or equal to .005 a t 2 and 5 years of age, respectively, for aortic annulus diameter, sinuses of Valsalva, and sinotubular junction). Heart rate, systolic blood pressure , stroke volume, hemoglobin, and hematocrit were not significantly associat ed with aortic root size. Left ventricular dilation, increased serum HIV RN A levels, and lower CD4 cell count measurements were associated with aortic root dilation at baseline. Conclusions Mild and nonprogressive aortic root dilation was seen in childr en with vertically transmitted HIV infection from 2 to 9 years of age. Aort ic root size was not significantly associated with markers for stress-modul ated growth; however, aortic root dilation was associated with left ventric ular dilation, increased viral load, and lower CD4 cell count in HIV-infect ed children. As prolonged survival of HIV-infected patients becomes more pr evalent, some patients may require longterm follow-up of aortic root size.