Abstract :
Background: An increasing relationship between HIV/AIDS, highly active anti – retroviral therapy (HAART) and cardiovascular diseases (CVD) have been noted over time. The occurrence of acquired immunodeficiency syndrome (AIDS) – associated heart disease found in post – mortem studies is notably higher than those diagnosed clinically implying that many HIV/AIDS patients may have cardiac abnormalities that are not diagnosed during their lifetime. This misdiagnosis persists even in the presence of dire consequences such as overt heart failure or even death.
Aim: This study set to determine what cardiac abnormalities are present in Nigerian HIV positive patients and what differences exist in the manifestations of these cardiac abnormalities between HIV positive patients who have been on HAART and those who are non-treated with HAART.
Methods: This was a cross-sectional analytical study with a comparison group in which two groups consisting of 76 HIV positive treatment naïve and 76 HIV positive HAART treated patients who met the inclusion criteria were sampled. The study protocol was reviewed and approved by the Research and Ethics Committee of the University of Benin Teaching Hospital, Benin City. All patients had an echocardiography done and data obtained was entered into and analyzed using the IBM-SPSS version 22.0. A p-value ≤ 0.05 was considered significant for all statistical comparisons done.
Results: Total prevalence of ECHO abnormalities was 91.4% in HIV Positive patients. Echocardiographic cardiac abnormalities were more prevalent in HAART treated patients [94.7%] than treatment naïve patients [ECHO = 88.2%]. The cardiac abnormalities found include increased LVMI, left ventricular diastolic dysfunction, increased left ventricular mass, pericardial effusion and abnormalities in left ventricular geometry. Pericardial effusion was more prevalent in treatment naïve patients with treatment naïve patients also noted to have the worst form of left ventricular geometry with over half having abnormal left ventricular geometric patterns compared to about 1/3rd in HAART treated patients.
Conclusion: Overall, HAART treated patients had cardiac abnormalities on echocardiogram than treatment naïve patients.
Keywords :
Echocardiography: Cardiac Abnormalities; HIV/AIDS; HAART Treated.References :
- Sadigh M, Puttagunta S. Cardiac manifestations of HIV. Front Biosci. 2003;8:s305-s13.
- Sani M, Okeahialam B. Epidemiology and pathogenesis of human immunodeficiency virus (HIV) related heart disease: a review. Nigerian journal of medicine: 2004;14(3):255-60.
- Chong G. Cardiovascular complications of HIV infection. Trinity Student Med J. 2004;5:31-6.
- Hecht SR, Berger M, Van Tosh A, Croxson S. Unsuspected cardiac abnormalities in the acquired immune deficiency syndrome: an echocardiographic study. Chest. 1989;96(4):805-8.
- Olusegun-Joseph D, Ajuluchukwu J, Okany C, Mbakwem A, Oke D, Okubadejo N. Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, south-west Nigeria: cardiovascular topic-online article. Cardiovascular journal of Africa. 2012;23(8):1-6.
- Bhardwaj A, Parikh R, Daoko J, Singh L, Shamoon F, Bhardwaj A, et al. Cardiovascular Manifestation of HIV: Review. Journal of Antivirals & Antiretrovirals. 2009;1(1):11-6.
- Strijdom H, De Boever P, Walzl G, Essop MF, Nawrot TS, Webster I, et al. Cardiovascular risk and endothelial function in people living with HIV/AIDS: design of the multi-site, longitudinal EndoAfrica study in the Western Cape Province of South Africa. BMC infectious diseases. 2017;17(1):41.
- Corallo S, Mutinelli M, Moroni M, Lazzarin A, Celano V, Repossini A, et al. Echocardiography detects myocardial damage in AIDS: prospective study in 102 patients. European heart journal. 1988;9(8):887-92.
- Marwadi M, Doctor N, Gheewala G, Barfiwala V, Rana J, Bavarva N. Cardiac Manifestations in HIV/AIDS Patients and their Correlation with CD4+ T Cell Count. National Journal of Medical Research. 2014;4(3):244-8.
- Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2002; 14:5-7. Available from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2002-vol-14.pdf Accessed 2020 May 30th.
- Samet JH, Freedberg KA, Stein MD, et al. Trillion virion delay: time from testing positive for HIV to presentation for primary care. Arch Intern Med. 1998 Apr 13;158(7):734–740.
- Mugavero MJ, Castellano C, Edelman D, Hicks C. Late diagnosis of HIV infection: the role of age and sex. Am J Med. 2007;120(4):370–373
- Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000 Mar 30;342(13):921–929
- Chow DC, Souza SA, Chen R, Richmond-Crum SM, Grandinetti A, Shikuma C. Elevated blood pressure in HIV-infected individuals receiving highly active antiretroviral therapy. HIV Clin Trials 2003;4:411-6.
- Seaberg EC, Munoz A, Lu M, et al. Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003. Aids. 2005;19:953–960.
- Herskowitz A, Wu TC, Willoughby SB, et al. Myocarditis and cardiotropic viral infection associated with severe left ventricular dysfunction in late-stage infection with human immunodeficiency virus. J Am Coll Cardiol. 1994;24:1025–1032.
- Frerichs FC, Dingemans KP, Brinkman K. Cardiomyopathy with mitochondrial damage associated with nucleoside reverse-transcriptase inhibitors. N Engl J Med. 2002;347:1895–1896
- Hsue PY, Lo JC, Franklin A, et al. Progression of Atherosclerosis as Assessed by Carotid Intima-Media Thickness in Patients With HIV Infection. Circulation. 2004
- Crane HM, Van Rompaey SE, Kitahata MM. Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy.AIDS. 2006; 20:1019–1026
- Thiébaut R, El-Sadr WM, Friis-Møller N, Rickenbach M, Reiss P, Monforte AD, Morfeldt L, Fontas E, Kirk O, De Wit S, Calvo G, Law MG, Dabis F, Sabin CA, Lundgren JD; Data Collection of Adverse Events of Anti-HIV Drugs Study Group. Predictors of hypertension and changes of blood pressure in HIV-infected patients.AntivirTher. 2005; 10:811–823.
- Baekken M, Os I, Sandvik L, Oektedalen O. Microalbuminuria associated with indicators of inflammatory activity in an HIV-positive population.Nephrol Dial Transplant. 2008; 23:3130–3137
- Palacios R, Santos J, García A, Castells E, González M, Ruiz J, Márquez M. Impact of highly active antiretroviral therapy on blood pressure in HIV-infected patients. A prospective study in a cohort of naive patients.HIV Med. 2006; 7:10–15.
- Tenorio AR, Zheng Y, Bosch RJ, Krishnan S, Rodriguez B, Hunt PW, Plants J, Seth A, Wilson CC, Deeks SG, Lederman MM, Landay AL. Soluble markers of inflammation and coagulation but not T-cell activation predict non-AIDS-defining morbid events during suppressive antiretroviral treatment.J Infect Dis. 2014; 210:1248–1259.
- Njoku PO, Ejim EC, Anisiuba BC, Ike SO, Onwubere BJ. Electrocardiographic findings in a cross-sectional study of human immunodeficiency virus (HIV) patients in Enugu, south-east Nigeria. Cardiovasc J Afr. 2016;27(4):252–257
- Nzuobontane D, Blackett KN, Kuaban C. Cardiac Involvement in HIV infected people in Yaounde Cameroon. Postgrad Med J. 2002;78:678–681
- Michael AB. Left ventricular hypertrophy: An overlooked cardiovascular risk factor. Cleveland Clin J Med. 2010;77(6):381–387.
- Heidenreich PA, Eisenberg MJ, Kee LL, et al. Pericardial effusion in AIDS. Incidence and survival. Circulation 1995;92: 3229-34
- Cegielski JP, Ramiya K, Lallinger GJ, Mtulia IA, Mbaga IM. Pericardial disease and human immunodeficiency virus in Dar es Salaam, Tanzania. Lancet.1990; 335:209-212.