CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
AFRICA
e1
Cardiovascular Topics
Echocardiographic patterns in treatment-naïve
HIV-positive patients in Lagos, south-west Nigeria
DA OLUSEGUN-JOSEPH, JNA AJULUCHUKWU, CC OKANY, AC MBAKWEM, DA OKE, NU OKUBADEJO
Abstract
Introduction:
Cardiovascular abnormalities are common in
HIV-infected patients, although often clinically quiescent.
This study sought to identify by echocardiography early
abnormalities in treatment-naïve patients.
Methods:
One hundred patients and 50 controls with no
known traditional risk factors for cardiovascular disease
were recruited for the study. The cases and controls were
matched for age, gender and body mass index. Both groups
had clinical and echocardiographic evaluation for cardiac
abnormalities, and CD
4
count was measured in all patients.
Results:
The cases comprised 57 females (57.0%) and 43
males (43.0%), while the controls were 28 females (56.0%)
and 22 males (44.0%) (
χ
2
=
0.01;
p
=
0.913).
The mean age of
the cases was 33.2
±
7.7,
while that of the controls was 31.7
±
9.7 (
t
=
1.02;
p
=
0.31).
Echocardiographic abnormalities were
significantly more common in the cases than the controls (78
vs 16%;
p
=
0.000),
including systolic dysfunction (30 vs 8%;
p
=
0.024)
and diastolic dysfunction (32 vs 8%;
p
=
0.002).
Other abnormalities noted in the cases were pericardial effu-
sion in 47% (
χ
2
=
32.10;
p
=
0.000)
and dilated cardiomyopa-
thy in 5% (five); none of the controls had either complica-
tion. One patient each had aortic root dilatation, mitral valve
prolapse and isolated right heart dilatation and dysfunction.
Conclusion:
Cardiac abnormalities are more common in
HIV-infected people than in normal controls.A careful initial
and periodic cardiac evaluation to detect early involvement
of the heart in the HIV disease is recommended.
Keywords:
HIV, cardiac abnormalities, echocardiography
Submitted 2/10/11, accepted 5/6/12
Published online 30/7/12
Cardiovasc J Afr
2012;
23
:
e1–e6
DOI: 10.5830/CVJA-2012-048
Human immunodeficiency virus (HIV) possesses an intrinsic
cardiopathogenic action that may be detected in even the early
stages of HIV disease.
1
The medical literature clearly documents
that HIV/AIDS is a multi-systemic disease, affecting virtually
every organ and system of the body, and causing progressive
dysfunction.
2-3
It is an established fact that the heart is not spared
in the exploits of this rampaging entity.
4-6
Cardiovascular abnormalities are common in HIV-infected
patients, although they are often clinically quiescent and
frequently attributed to dysfunction in other organ systems.
7-9
Of interest is the observation that the incidence of AIDS-related
heart disease found in post-mortem studies is significantly
higher than the incidence of abnormalities diagnosed clinically
ante mortem.
10
Therefore it is possible that many AIDS patients
have cardiac abnormalities that are not recognised during the
course of their illness.
In an autopsy study carried out in 1998, cardiac abnormalities
were noted in two-thirds of the patients with AIDS.
11
These
abnormalities, which were attributed directly or indirectly to
the HI virus and/or treatment side effects, could largely have
been detected early ante mortem using echocardiography, a
non-invasive, radiation-free investigation.
10,12,13
Cardiac involvement impacts on the natural history and
prognosis of the HIV disease. This demands an awareness by
clinicians of its cardiovascular manifestations for a complete
and rational diagnosis and management.
5
This study sought to
identify echocardiographic abnormalities in treatment-naïve
patients in order to assess the cardiac effects of HIV infection,
while excluding drug effects.
Methods
This was a descriptive, cross-sectional study of 100 patients
with HIV infection recruited via the HIV clinic of the Lagos
University Teaching Hospital (LUTH), Lagos, Nigeria. The
patients were yet to commence antiretroviral therapy. The
cohort was made up of HIV-infected individuals referred to,
or identified in the clinic. They had no prior history of cardiac
disease, and were not previously diagnosed as hypertensive or
diabetic. Those with a history of use of illicit drugs or previous
treatment with drugs with cardiotoxic effects were excluded.
Department of Cardiology, Lagos University Teaching
Hospital, Lagos, Nigeria
DA OLUSEGUN-JOSEPH, MB BS, FWACP,
Department of Cardiology, Lagos University Teaching
Hospital, Lagos; Department of Medicine, College of
Medicine, University of Lagos, Lagos, Nigeria
JNA AJULUCHUKWU, MB BS, FMCP
AC MBAKWEM, MB BS, FWACP
DA OKE, MB BS, FMCP
NU OKUBADEJO, MB ChB, FMCP
Department of Cardiology, Lagos University Teaching
Hospital, Lagos; Department of Haematology, College of
Medicine, University of Lagos, Lagos, Nigeria
CC OKANY, MB BS, FWACP
