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HIV-Related Research on Pediatric Heart, Lung, and Blood Diseases

HIV-Focused Research Goals

NHLBI supports research on the effects of HIV on children and young adults. Such research attempts not only to characterize the natural history of the disease from the intrauterine environment through childhood and adolescence, but also to understand the effect of antiretroviral therapy on developing organ systems. Children with HIV have been shown to have accelerated development of cardiovascular risk factors, including lipid abnormalities and abnormal markers of cardiovascular risk. They are also at risk of cardiomyopathy resulting from both viral infection and long-term treatment with antiretroviral therapy.

Previously Funded Studies

In 2005, the Pediatric HIV/AIDS Cohort Study (PHACS)external disclaimer was established to address the long-term safety of fetal and infant exposure to prophylactic antiretroviral (ART) therapy and the effects of perinatally acquired HIV infection in adolescents. This network of 24 clinical sites across 13 states and Puerto Rico runs two major protocols and studies many facets of pediatric HIV. PHACS' goals germane to the NHLBI include characterization of cardiac structural and functional abnormalities in HIV-infected children. This will be achieved by exploring abnormalities in cardiac function related to ART and/or HIV exposure as well as metabolic risk factors for cardiovascular disease, including abnormal glucose metabolism, lipid abnormalities, and body composition.

The Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection Study (P2C2) was a prospective natural history study at five clinical centers in the United States during the era before antiretroviral therapy was widely available (1990-1997). The P2C2 study helped define the spectrum of cardiovascular and pulmonary disease in HIV-infected children and uninfected children born to HIV-infected mothers.

Stored serum samples from the P2C2 study may be requested by qualified investigators through the NHLBI Biologic Specimen and Data Repository (BioLincc).

Future Directions

Selected pediatric research examples of interest to the NHLBI AIDS Program include, but are not limited to, studies that:

  • Investigate the long-term effects of antiretroviral therapy on the cardiovascular, lung, and blood systems in children and young adults.
  • Characterize the mechanism of and subsequent cardiovascular risk in children and young adults of lipid abnormalities due to long-term antiretroviral therapy.
  • Understand the role of both HIV and long-term antiretroviral therapy on the development of cardiomyopathy.
  • Define HIV-related pulmonary disease in pediatric cohorts in the era of antiretroviral therapy

Selected Pediatric-Related Publications Supported by the NHLBI AIDS Program

  • Lipshultz SE, Williams PL, Wilkinson JD, Lester EC, Van Dyke RB, Shearer WT, Rich KC, Hazra R, Kaltman JR, Jacobson DL, Dooley LB, Scott GB, Rabideau N, Colan SD, for the Pediatric HIV/AIDS Cohort Study (PHACS), Cardiac Status of Children Infected with Human Immunodeficiency Virus Who Are Receiving Long-term Combination Antiretroviral Therapy, JAMA Pediatr, Online, 4/22/13.
  • Wilkinson JD, Williams PL, Leister E, Zeldow B, Shearer WT, Colan SD, Siberry GK, Dooley LB, Scott GB, Rich KC, Lipshultz SE; for the Pediatric HIVAIDS Cohort Study (PHACS). Cardiac Biomarkers in HIV-Exposed Uninfected Children: The Pediatric HIV/AIDS Cohort Study (PHACS). AIDS. 2012 Dec 3. [Epub ahead of print] PMID: 23211773
  • Perez-Atayde AR, Kearney DI, Bricker JT, Colan SD, Easley KA, Kaplan S, Lai WW, Lipshultz SE, Moodie DS, Sopko G, Starc TJ; P2C2 HIV Study Group. Cardiac, aortic, and pulmonary arteriopathy in HIV-infected children: the Prospective P2C2 HIV Multicenter Study. Pediatr Dev Pathol. 2004 Jan- Feb;7(1):61-70. PMID: 15255036
  • Langston C, Cooper ER, Goldfarb J, Easley KA, Husak S, Sunkle S, Starc TJ, Colin AA; P2C2 HIV Study Group. Human immunodeficiency virus-related mortality in infants and children: data from the pediatric pulmonary and cardiovascular complications of vertically transmitted HIV (P2C2) Study. Pediatrics. 2001 Feb;107(2):328-38. PMID11158466
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