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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016
254
AFRICA
Themeandurationof HAARTmedicationfortheHIV-positive
patients on HAART was 4.0
±
2.4 years, with minimum and
maximum durations of one and 10 years, respectively. Of these
patients, 7% took the HAART regimen containing protease
inhibitors (PIs), while 93% took HAART that did not contain
PIs. However, those on PIs received it for less than six months.
Table 4 shows ECG abnormalities in the study groups and
controls. T-wave inversion (
<
3 mm) in leads V1–V3 (anterior
leads) was the commonest abnormality in all study groups. It
was seen in 44 (65.7%) of the HIV-positive subjects on HAART,
22 (45.8%) of the HIV-positive HAART-naïve subjects and 14
(29.2%) of the controls. T-wave inversion (
<
3 mm) in leads
II, III and aVF (inferior leads) was also seen in two (2.2%)
HIV-positive subjects on HAART, one (1.4%) HIV-positive
HAART-naïve subject, and six (15.8%) control subjects.
Left-axis deviation (LAD), that is, QRS axis of
<
0° to
90°, was seen in 15 (16%) of the HIV subjects on HAART, 10
(13.7%) of the HAART-naïve subjects and eight (21%) of the
controls. First-degree heart block (PR interval
>
0.2 s) was seen
in three (3.2%) HIV-positive subjects on HAART, one (2.1%)
HIV-positive HAART-naïve subject, and two (5.3%) control
subjects.
One (1.1%) subject with low QRS-wave voltage complex
(amplitude of QRS complex
<
5 mm in limb leads or
>
10 mm
in precordial leads), left bundle branch block (LBBB), and right
bundle branch block (RBBB), respectively, was found in the
group of HIV-positive subjects on HAART, while eight (11%)
subjects with left ventricular hypertrophy (LVH) and two (2.7%)
with ST-segment elevation were found among the HIV-positive
HAART-naïve subjects.
Sinus tachycardia (heart rate
>
100 beats per minute) was
seen in eight (8.6%) HIV-positive subjects on HAART, and 14
(19.2%) control subjects, while sinus bradycardia (heart rate
<
60 beats per minute) was seen in only two (5.3%) of the control
subjects. Prolonged QTc (QTc
>
0.44 in males or
>
0.46 in
females) 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 control subjects.
Discussion
The prevalence of ECG abnormalities was higher among
HIV-positive patients on HAART (93%) and HIV-positive
HAART-naïve patients (73%), compared to the controls
(38%) (Table 4). Okoye
19
found a similar prevalence of ECG
abnormalities in 80% of AIDS patients with CD4 cell counts
<
200 cells/mm
3
, 60% of HIV-positive subjects with CD4 cell
counts
>
200 cells/mm
3
and 35% of HIV-negative healthy controls.
The prevalence of ECG abnormalities found in both
HIV-positive patients on HAART and HIV-positive HAART-
naïve patients in this study also compared favourably with the rate
of 86% reported by Mouanodji
et al.
20
Conversely, the prevalence
of ECG abnormalities in this study was significantly higher than
the 53% found by Levy
et al
.
21
and the 55% documented by Herst
et al
.
22
The difference may have been due to the small sample sizes
of 32 and 21 patients in the studies done by Levy
et al
. and Herst
et al
., respectively. Also, not matching the numbers in the study
groups, as well as inclusion of patients at advanced stages of
AIDS by Levy
et al
. could have been reasons for the discrepancy.
LAD, T-wave inversion in leads V1–V3 and prolonged QTc
were the three most common ECG abnormalities found in
HIV-positive patients on HAART and HIV-positive HAART-
naïve patients, respectively, in this study (Table 4). LAD and
T-wave inversion in leads II, III, avF and V1–V3 were the three
most common ECG abnormalities in the controls. LAD was
found more often in both HIV-positive patients on HAART
and HIV-positive HAART-naïve patients than in the control
subjects. T-wave inversion in leads V1–V3 was the commonest
ECG abnormality in all the groups, occurring in 47% of the
HIV-positive patients on HAART, 30.4% of the HIV-positive
HAART-naïve patients and 36.8% of the controls. It also
occurred in smaller proportions in leads II, III, avF, I and
avL. T-wave inversion may signify ischaemia but is often a
non-specific finding, especially in women.
23
No relationship
between ECG abnormalities and gender was found in the study.
ECG evidence of asymptomatic ischaemic heart disease
(IHD) (Q wave or ST-segment depression) was not found in
Table 3. Age distribution in the study groups
Age
(years)
HIV-positive on
HAART,
n
(%)
HIV-positive
HAART-naïve,
n
(%)
HIV-negative
control,
n
(%)
Total,
n
(%)
<
26
11 (23.9)
19 (41.3)
16 (34.8)
46 (100)
26–30
22 (37.9)
19 (32.8)
17 (29.3)
58 (100)
31–35
21 (30.0)
24 (34.3)
25 (35.7)
70 (100)
36–40
17 (35.4)
16 (33.3)
15 (31.3)
48 (100)
41–45
13 (46.4)
7 (25.0)
8 (28.6)
28 (100)
46–50
9 (31.0)
9 (31.0)
11 (37.9)
29 (100)
>
50
7 (33.3)
6 (28.6)
8 (38.1)
21 (100)
Total
100 (33.3)
100 (33.3)
100 (33.3)
300 (100)
χ
2
=
4.739,
p
=
0.192. HIV
=
human immunodeficiency virus; HAART
=
highly
active antiretroviral therapy.
Table 4. ECG abnormalities in the study population
ECG abnormalities
HIV-
positive on
HAART,
n
(%)
HIV-
positive
HAART
naïve,
n
(%)
Control,
n
(%)
χ
2
p
-value
LAD
15 (16)
10 (13.7)
8 (21)
2.656 0.265
T wave inversion in
leads V1 –V3
44 (47)
22 (30.4)
14 (36.8)
24.682
<
0.001
Low QRS voltage
complex
1 (1.1)
0 (0)
0 (0)
2.007 0.367
1st-degree heart block 3 (3.2)
1 (1.4)
2 (5.3)
1.020 0.600
T-wave inversion in
leads II, III, aVF
(inferior leads)
2 (2.2)
1 (1.4)
6 (15.8)
4.811 0.090
VEB
1 (1.1)
1 (1.4)
0 (0)
2.007 0.367
T-wave inversion in
leads I, aVL,V5–V6
(lateral leads)
0 (0)
2 (2.7)
2 (5.3)
2.027 0.363
LBBB
1 (1.1)
0 (0)
0 (0)
2.007 0.367
RBBB
1 (1.1)
0 (0)
2 (5.3)
2.020 0.364
LVH
0 (0)
8 (11)
0 (0)
16.438
<
0.001
Sinus tachycardia
8(8.6)
14 (19.2)
0 (0)
2.020 0.364
ST-segment elevation 0 (0)
2 (2.7)
0 (0)
4.027 0.134
Sinus bradycardia
0 (0)
0 (0)
2 (5.3)
25.000
<
0.001
Mean QTc
±
SD 0.42
±
0.04 0.41
±
0.04 0.39
±
0.03 *15.779
<
0.001
Prolonged QTc
17 (18.2)
12 (16.4)
4 (10.5)
8.784 0.012
Total
93 (100)
73 (100)
38 (100)
*
F
-value. For QTc,
F
=
15.779;
p
<
0.001. Duncan
post hoc
multiple comparison
test showed all significantly different.
LAD
=
left axis deviation, VEB
=
ventricular ectopic beat, LBBB
=
left bundle
branch block, RBBB
=
right bundle branch block, LVH
=
left ventricular hyper-
trophy.