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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
236
AFRICA
Echocardiographic abnormalities in children and
adolescents living with human immunodeficiency virus
on highly active antiretroviral treatment
Tewolde Wubayehu, Workeabeba Abebe, Endale Tefera
Abstract
Background:
The availability and use of highly active antiret-
roviral treatment (HAART) has turned human immunodefi-
ciency virus (HIV) into a chronic disease, allowing patients to
live much longer.
Objectives:
To report asymptomatic cardiac abnormalities
in children and adolescents based on both conventional and
tissue Doppler imaging (TDI) echocardiography.
Methods:
One hundred and fifty-one patients on HAART
were recruited. Demographic and clinical variables were
collected through patient interviews and medical record
reviews. Conventional echocardiography and TDI were
performed on each patient.
Results:
Mean age was 13.0
±
3.2 (4.0–19.0) years. Eighty-
three patients (55%) were female. Age at diagnosis of HIV
infection was 5.7
±
3.3 years. Age at initiation of HAART
was 7.34
±
3.54 years, while duration of HAART was 59
±
39.1 months. On conventional echocardiography, three cases
of left ventricular (LV) systolic dysfunction, two of pulmo-
nary hypertension and one of minimal pericardial effusion
were identified. Calculation of myocardial mass index (MMI)
revealed that 16 patients had abnormal values. Twenty-seven
(17.9%) patients had evidence of LV diastolic dysfunction
and 18 (11.9%) had right ventricular (RV) diastolic dysfunc-
tion. Nineteen (12.6%) patients had tricuspid annular systolic
velocity of
<
9.5 cm/s, indicating asymptomatic RV systolic
dysfunction.
Conclusion:
While few patients had abnormalities such as
reduced LV ejection fraction, pulmonary hypertension and
minimal pericardial effusion detectable on conventional echo-
cardiography, a larger proportion of patients had subtle
abnormalities such as increased MMI, LV diastolic dysfunc-
tion on TDI, RV dysfunction and abnormal myocardial
performance index. Such patients may need routine screening
and cardiac follow up.
Keywords:
echocardiographic abnormalities, HIV-infected
children, cardiac involvement, myocardial mass index, tissue
Doppler imaging
Submitted 17/8/19, accepted 28/12/19
Published online 5/2/20
Cardiovasc J Afr
2020;
31
: 236–240
www.cvja.co.zaDOI: 10.5830/CVJA-2019-072
Close to 90% of children infected with human immunodeficiency
virus (HIV) live in sub-Saharan Africa.
1
Most of these children
are believed to have acquired the infection via mother-to-
child transmission. The availability and use of highly active
antiretroviral treatment (HAART) has turned HIV into a
chronic disease, allowing patients to live much longer.
2
Cardiac abnormalities are frequent in HIV-infected children,
most of whom remain asymptomatic.
3,4
Subclinical cardiac
abnormalities in HIV-infected children are common, persistent
and often progressive.
5-8
Various mechanisms may lead to cardiac
involvement in HIV including direct cytopathic effect of the
HI virus, HIV-related opportunistic infections and effects of
HAART on the heart.
9
Myocarditis, dilated cardiomyopathy,
inappropriate left ventricular (LV) hypertrophy/increased
LV mass, impaired LV diastolic function, pericarditis and
pulmonary hypertension are just some of the many forms of
cardiac pathologies that HIV patients may present with.
4-8,10-13
It is also believed that the use of HAART has played a role in
transforming HIV-associated heart disease from symptomatic to
mild and asymptomatic conditions.
14
Studies from sub-SaharanAfrica have also reported significant
incidence of cardiac involvement in HIV-infected children in
both the pre-HAART and HAART era.
2,3,13-16
Of the estimated
738 976 patients living with HIV in Ethiopia, about 178 500
were believed to be children under 15 years of age. Although
antiretroviral treatment (ART) has been provided free of charge
in Ethiopia since 2005, ART coverage for children under 15 years
of age remains one of the lowest in the world, being at 23.5% of
treatment-eligible children.
17
This study reports asymptomatic
cardiac abnormalities that may exist in children and adolescents,
based on both conventional and tissue Doppler imaging (TDI)
echocardiography.
Methods
This was a cross-sectional study of children and adolescents
living with HIV who were on HAART and being followed at the
Paediatric Infectious Disease Clinic of the Addis Ababa University
Hospital (Tikur Anbessa Specialised Hospital), the largest referral
Department of Paediatrics and Child Health, Aksum
University, Aksum, Ethiopia
Tewolde Wubayehu, MD
Department of Paediatrics and Child Health, Division of
Infectious Diseases, School of Medicine, Addis Ababa
University, Addis Ababa, Ethiopia
Workeabeba Abebe, MD
Department of Paediatrics and Adolescent Health, Division
of Cardiology, Faculty of Medicine, University of Botswana,
Gaborone, Botswana
Endale Tefera, MD,
endalet2008@gmail.com