Cardiovascular Journal of Africa: Vol 27 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016 AFRICA 25
Left ventricular systolic function in Nigerian children
infected with HIV/AIDS: a cross-sectional study
Ijeoma Arodiwe, Anthony Ikefuna, Egbuna Obidike, Ejikeme Arodiwe, Bennedict Anisuba, Ngozi
Ibeziako, Sunday Omokoidion, Christy Okoroma
Abstract
Background: Cardiac complications contribute significantly
to morbidity and mortality in children with HIV/AIDS.
These rates have been under-reported in sub-Saharan African
children.
Methods: This was an observational, cross-sectional Doppler
echocardiographic study of ventricular systolic function,
performed at a tertiary clinic on children with HIV/AIDS.
Results: Left ventricular systolic dysfunction was present
in 27.0% of the children with HIV infection and 81.2% of
those with AIDS. The mean fractional shortening in the
AIDS group (31.6 ± 9.5%) was significantly lower than in the
HIV-infected group (35.3 ± 10.5%, p = 0.001). A significant
correlation was found with CD4+ cell count and age, and these
were the best predictors of left ventricular systolic dysfunc-
tion in the stepwise multiple regression analysis (r = 0.396, p =
0.038; r = –0.212, p = 0.025, respectively).
Conclusion: Left ventricular systolic dysfunction is common
in Nigerian children with HIV/AIDS.
Keywords: left ventricular systolic function, HIV/AIDS, children,
echocardiography, Nigeria
Submitted 11/4/15, accepted 25/8/15
Cardiovasc J Afr 2016; 27: 25–29
DOI: 10.5830/CVJA-2015-066
Human immune deficiency virus (HIV) infection and its effect,
acquired immune deficiency syndrome (AIDS), is one of the
most frightening emerging diseases and constitutes a global
health burden with overwhelming social, economic and political
repercussions.1 It is one of the challenges facing African countries
today, as most countries in sub-Saharan Africa have generalised
epidemics, defined as prevalence rate > 1%. It is a leading cause
of death and shortened life expectancy in this region.2
This disease is characterised by a deficient cell-mediated
immunity.3 The manifestation is usually protean, as shown by
varied clinical features seen in different parts of the world.4 It
results in a progressive dysfunction of multiple organ systems. 5 In
sub-Saharan Africa where the burden of the disease is very high,
involvement of the heart in HIV has become a clinical problem
over the last decade, but there are few published studies on it,
especially in children.6-8
Left ventricular dysfunction is important in the clinical history
and prognosis of HIV infection.9 It is most often clinically silent
in HIV/AIDS patients and can progress to symptomatic left
heart failure.10 Median survival to AIDS-related death is 101
days in patients with left ventricular dysfunction, and 472 days
in patients with a normal heart, as shown by echocardiography
at a similar infection rate.11 Reduced left ventricular fractional
shortening and increased wall thickness were also predictive of
survival after multivariate adjustment. 11 With improved clinical
surveillance and treatment, using highly active antiretroviral
therapy (HAART), more patients are surviving potentially
fatal opportunistic infections, only to succumb to neoplasm or
end-organ damage. Heart muscle disease is one such end-organ
damage.12
Our study evaluated left ventricular systolic function (LVSF)
and factors affecting it in children with HIV and AIDS,
compared with age- and gender-matched HIV-negative controls,
using M-mode, two-dimensional and Doppler echocardiography.
Methods
This was a descriptive, cross-sectional study of 90 paediatric HIV
and AIDS patients, aged between 18 months and 14 years. Their
age and gender matched the HIV-free controls. The cases were
seen at the University of Nigeria Teaching Hospital (UNTH),
Enugu, from February to December 2011. The study was carried
out at the Paediatric retroviral clinic and in the paediatric wards.
Those in the wards are already confirmed to be HIV positive
or have AIDS. The controls were recruited from the children’s
out-patient department, immunisation and adolescent clinic.
The patients had a pre-echocardiography evaluation to
identify those qualifying for the study. The inclusion criteria
were children who were HIV 1 and/or 2 positive, confirmed by
Western blot technique or DNA PCR, who were or were not
on HAART. The exclusion criteria included children who were
on medications with known cardiovascular effects, such as anti-
arrhythmic drugs, theophylline and adriamycin, children with
pre-existing cardiac diseases, and children with other chronic
diseases associated with demonstrable wasting or oedema.
Department of Paediatrics, University of Nigeria Teaching
Hospital, Ituku-Ozalla, Enugu, Nigeria
Ijeoma Arodiwe, MD,
Anthony Ikefuna, MD
Egbuna Obidike, MD
Ngozi Ibeziako, MD
Department of Medicine, College of Medicine, University of
Nigeria, Enugu, Nigeria
Ejikeme Arodiwe, MD
Bennedict Anisuba, MD
Department of Paediatrics, University College Hospital,
Ibadan, Nigeria
Sunday Omokoidion, MD
Department of Paediatrics, College of Medicine, University
of Lagos, Lagos, Nigeria
Christy Okoroma, MD