Document 0536
 DOCN  M9610536
 TI    Immunoglobulins and left ventricular structure and function in pediatric
       HIV infection.
 DT    9601
 AU    Lipshultz SE; Orav EJ; Sanders SP; Colan SD; Department of Cardiology,
       Children's Hospital, Boston, MA 02115,; USA.
 SO    Circulation. 1995 Oct 15;92(8):2220-5. Unique Identifier : AIDSLINE
       MED/96017301
 AB    BACKGROUND: Progressive left ventricular (LV) dilation is common in
       children infected with HIV-1 and may be a harbinger of congestive heart
       failure (CHF). In many HIV-infected children, dilation is associated
       with inadequate LV hypertrophy, elevated afterload, and reduced LV
       function. Because CHF has been observed empirically to improve after
       treatment with intravenous immunoglobulin (IVIG) in other conditions and
       because LV dysfunction in pediatric HIV may be immunologically mediated,
       we examined retrospectively the relation between immunoglobulins and LV
       structure and function in 49 HIV-infected infants and children without
       CHF. METHODS AND RESULTS: A total of 106 echocardiograms were performed
       in these children within 30 days of serum immunoglobulin (IgG, IgA, and
       IgM) measurements; this includes 12 children treated with IVIG therapy.
       All echocardiographic parameters, blood pressures, and immunoglobulins
       were adjusted for age or body surface area and subjected to
       repeated-measures regression. Regression models were adjusted
       simultaneously for endogenous IgA, IgG, IgM, IVIG therapy, zidovudine
       therapy, age, HIV disease stage, and weight. Higher endogenous serum IgG
       levels and IVIG treatment were associated with significantly greater
       wall thickness and lower peak wall stress. Higher endogenous serum IgA
       levels were associated with more normal LV wall thickness and LV
       thickness-to-dimension ratios. LV contractility, fractional shortening,
       end-systolic wall stress, and thickness-to-dimension ratio all showed a
       trend toward more normal values with higher endogenous immunoglobulin
       values or during IVIG treatment. CONCLUSIONS: LV structure and function
       appear to be more normal in HIV-infected children who receive IVIG
       treatment and in those with higher endogenous IgG levels. These results
       suggest that both the impaired myocardial growth and the LV dysfunction
       observed may be immunologically mediated and responsive to
       immunomodulatory therapy.
 DE    Case-Control Studies  Child  Child, Preschool  Cohort Studies
       Echocardiography  Human  Hypertrophy, Left
       Ventricular/*ETIOLOGY/PHYSIOPATHOLOGY/  ULTRASONOGRAPHY  HIV
       Infections/COMPLICATIONS/*PHYSIOPATHOLOGY/*THERAPY
       Immunoglobulins/*BLOOD  Immunoglobulins, Intravenous/*THERAPEUTIC USE
       Multivariate Analysis  Support, Non-U.S. Gov't  Support, U.S. Gov't,
       P.H.S.  Ventricular Dysfunction, Left/*ETIOLOGY/PHYSIOPATHOLOGY/
       ULTRASONOGRAPHY  Ventricular Function, Left/*PHYSIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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