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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016
252
AFRICA
Electrocardiographic findings in a cross-sectional study
of human immunodeficiency virus (HIV) patients in
Enugu, south-east Nigeria
PO Njoku, EC Ejim, BC Anisiuba, SO Ike, BJC Onwubere
Abstract
Background:
Electrocardiographic (ECG) abnormalities are
prevalent in subjects with human immunodeficiency virus
(HIV) infection. In this study, three groups of subjects were
investigated and the prevalence of ECG abnormalities was
analysed.
Methods:
A cross-sectional study was carried out on adults
betweenNovember 2010 andNovember 2011 at the University
of Nigeria Teaching Hospital, Enugu, Nigeria. One hundred
HIV-infected patients on highly active anti-retroviral therapy
(HAART), 100 HIV-infected HAART-naïve patients and 100
HIV-negative controls were recruited. Twelve-lead electrocar-
diograms were done on all subjects. Data were analysed using
the chi-squared, Student’s
t
-, one-way ANOVA and Duncan
post hoc
tests.
Results:
Left-axis deviation was seen in 15 (16%) of the
HIV-positive subjects on HAART, 10 (13.7%) of the
HAART-naïve subjects and eight (21%) of the controls (
p
=
0.265). Eight (11%) subjects with left ventricular hypertro-
phy (
p
<
0.001) and two (2.7%) with ST-segment elevation
were found among the HIV-positive HAART-naïve subjects
(
p
=
0.134). Prolonged QTc interval was seen in 17 (18.2%)
of the HIV-positive patients on HAART, 12 (16.4%) of the
HIV-positive HAART-naïve patients and four (10.5%) of the
controls (
p
=
0.012).
Conclusion:
The prevalence of ECG abnormalities was higher
in the HIV-positive patients on HAART (93%) and the
HIV-positive HAART-naïve patients (73%) compared to the
controls.
Keywords:
abnormalities, electrocardiogram, highly active anti-
retroviral therapy, human immunodeficiency virus
Submitted 19/11/15, accepted 26/1/16
Cardiovasc J Afr
2016;
27
: 252–257
www.cvja.co.zaDOI: 10.5830/CVJA-2016-007
The global prevalence of HIV/AIDS in people aged 15–49
years was 0.8% in 2011,
1
affecting approximately 34 million
people. An estimated 23.5 million (22.1–24.8 million) of these
people, representing 69% of the global HIV burden, reside in
sub-Saharan Africa.
2
Worldwide, Nigeria has the second highest
number of new infections reported each year, and an estimated
3.7% of the population or 3.4 million people are living with HIV
infection.
3,4
With increased access to anti-retroviral therapy (ART) in
resource-poor countries, longevity has increased among people
living with HIV/AIDS.
5
Indeed, dramatic reductions in morbidity
and mortality rates have been noted in these patients since the
introduction of ART in 1996. In Nigeria, this has prolonged and
improved the quality of life of HIV/AIDS patients, with survival
data of 68.3% of adults and children who were on ART in 2009,
alive and healthy after 12 months.
6
Although the use of highly active anti-retroviral therapy
(HAART) is associated with virological suppression and
immunological recovery in people living with HIV infection, HIV
and HAART, especially protease inhibitors, induce disorders of
lipid metabolism,
7,8
such as diabetes and dyslipidaemia, which are
implicated in the increased incidence of cardiovascular disease in
this patient population.
9,10
The electrocardiogram (ECG) identifies abnormalities in
HIV/AIDS patients whether or not they were suspected of
having cardiac disease.
11
Barbaro and colleagues found ECG
abnormalities, including supraventricular and ventricular ectopic
beats, as well as non-specific ST–T-wave abnormalities in about
57% of asymptomatic HIV-infected patients.
12
Sani and colleagues
13
documented abnormal ECG findings in
81%of 100 AIDS patients, 65%of 78 HIV-positive asymptomatic
subjects and 37.5% of 80 HIV-negative subjects. The ECG
abnormalities described included different types of arrhythmias,
low-voltage QRS complexes, non-specific ST-segment and
T-wave changes, poor R-wave progression, right bundle branch
block, axis deviations, enlargement of various heart chambers
and QTc prolongation.
AsymptomaticECGfindings specific formyocardial ischaemia
(Q waves and ST-segment depression, and T-wave inversion in
men) signify an increased risk of myocardial infarction or death
in HIV-uninfected adults,
14
and may have worse consequences
in HIV-infected individuals. The ECG, which is fairly widely
available in resource-poor countries, is helpful in evaluating HIV
subjects for cardiovascular disease.
Considering the huge impact of the HIV/AIDS disease
burden in sub-Saharan Africa, increasing access to HAART
as well as the improved longevity of people living with HIV/
AIDS, there is a need for proper cardiovascular evaluation of
this patient population. Early identification and management of
cardiovascular diseases in this population would optimise patient
Department of Medicine, University of Nigeria Teaching
Hospital, Ituku-Ozalla, Enugu, Nigeria
PO Njoku, MB BS, MSc, FMCP,
passyokuchi@yahoo.comEC Ejim, MB BS, FMCP
BC Anisiuba, MB BS, FMCP
SO Ike, MB BS, FMCP
BJC Onwubere, MB BS, FMCP
Department of Medicine, Federal Medical Centre, Keffi,
Nasarawa State, Nigeria
PO Njoku, MB BS, MSc, FMCP,
passyokuchi@yahoo.com