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Decreased Prevalence of Rheumatic Heart Disease Confirmed Among HIV-positive Youth

Hovis, Ian W., MD*; Namuyonga, Judith, MBBS; Kisitu, Grace P., MBBS; Ndagire, Emma, MBBS; Okello, Emmy, MD; Longenecker, Chris T., MD§; Sanyahumbi, Amy, MD; Sable, Craig A., MD*; Penny, Daniel J., MD; Lwabi, Peter, MD; Kekitiinwa, Adeodata R., MBBS; Beaton, Andrea, MD*

The Pediatric Infectious Disease Journal: April 2019 - Volume 38 - Issue 4 - p 406–409
doi: 10.1097/INF.0000000000002161
HIV Reports
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Background: There is geographical overlap between areas endemic for rheumatic heart disease (RHD) and those endemic for HIV. A recent pilot study demonstrated that children living with HIV might be at less risk for RHD development; however, the sample size was too small to make definitive conclusions. Our objective was to determine the prevalence of RHD among HIV-positive children in Uganda.

Methods: We conducted a prospective, cross-sectional study of HIV-positive children (5–15 years of age) receiving care at the Baylor Uganda HIV Clinic, Kampala, Uganda. A focused echocardiogram and chart review was performed. A sample size of 988 children was needed to provide 80% power to detect a difference in population prevalence between HIV-positive children and the general population, 2.97% [95% confidence interval (CI): 2.70–3.24%], based on previous reports.

Results: Screening echocardiography of 993 HIV-positive children found 15 individuals (1.5%; 95% CI: 0.88%–2.54%) with RHD. Of these 15, 2 were classified as definite RHD and 13 as borderline RHD. The majority of children had isolated mitral valve disease (93%). Children found to have RHD were older than those without RHD, 12 versus 10 years of age (P = 0.004). When separated based on geographic location, the prevalence of RHD among HIV-positive children from Kampala was 1.28% (95% CI: 0.63%–2.51%) compared with 2.1% (95% CI: 0.89%–4.89%) in those from outside Kampala.

Conclusions: Children living with HIV have a lower prevalence of RHD than the general pediatric population. Further studies are needed to explore this protective association.

From the *Children’s National Health System, Washington, District of Columbia

Uganda Heart Institute

Baylor College of Medicine Children’s Foundation, Mulago Hospital, Kampala, Uganda

§Case Western Reserve University School of Medicine, Cleveland, Ohio

Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas.

Accepted for publication June 14, 2018.

Supported by the Children’s National Medical Center Global Health Initiative, the National Institutes of Health (K23 HL123341 to C.T.L.) and General Electric.

The authors have no conflicts of interest to disclose.

Address for correspondence: Ian W. Hovis, MD, Children’s National Health System, Washington, DC. E-mail: ihovis@cnmc.org

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