Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 322 AFRICA Lopinavir-ritonavir (LPV/r) 400/100 mg BD. They were given in proportion according to the Nigerian guidelines 21 (Table 3). Other medications received were mainly Co-trimoxazole 960 mg, Artemether/Lumefantrine 80 mg/480 mg, Clotrimazole cream, Fluconazole 200 mg, Diphenoxylate 5 mg, Metronidazole 400 mg, Mebendazole 400 mg, Fesolate 200 mg, paracetamol and multivitamins. For the patients on HAART, the mean duration of HAART medication was 4.0 ± 2.4 years with a minimum and maximum duration of one and 10 years, respectively. Seven per cent of these patients were on a PI-containing HAART regimen while 93% were on a non-PI regimen. Those on a PI regimen received it for less than six months. Between the HIV-positive patients on HAART and HIV-positive, HAART-naïve groups, there was a significant difference in the number of subjects with weight loss, skin lesions, body weakness, oral thrush and peripheral lymphadenopathy ( p < 0.05) (Table 4). Forty-nine per cent of HIV-positive, HAART-naïve patients had weight loss compared to 12% in the group of HIV-positive patients on HAART. Similarly, 14% of HIV-positive, HAART-naïve patients had dermatological lesions, compared to only 2% of the group of HIV-positive patients on HAART. Twenty-four per cent of HIV-positive, HAART-naïve patients had generalised body weakness compared to 5% of patients in the HIV-positive group on HAART. Similarly, 10% of HIV-positive, HAART-naïve patients had oral thrush and peripheral lymphadenopathy, respectively, compared to 1% in the HIV-positive group on HAART. The mean CD4 cell count for the HIV-positive patients on HAART was 408.43 ± 221.62 cells/mm 3 , while that of the HIV-positive, HAART-naïve group was 250.06 ± 154.26 cells/ mm 3 . There was a significant difference between the means of the CD4 cell counts between HIV-positive patients on HAART and HIV-positive, HAART-naïve patients ( t = 5.865, p < 0.001). There was also a significant difference in the number of subjects with CD4 cell counts < 200 cells/mm 3 and those with CD4 cell counts ≥ 200 cells/mm 3 in both HIV-positive patients on HAART and HIV-positive, HAART-naïve groups ( χ 2 = 16.095, p < 0.001). There were more ECG abnormalities in HIV patients on HAART compared to HAART-naïve patients and the controls (Table 5). T-wave inversion in leads VI–VIII occurred in 44% of the HIV-positive patients on HAART, 22% of HIV-positive, HAART-naïve patients and 8% of the controls ( χ 2 = 24.682, p < 0.001). Left ventricular hypertrophy (LVH) was found in only the HIV-positive, HAART-naïve patients ( p < 0.001). Comparing some echocardiographic parameters measured across the groups using one-way ANOVA, there was a significant difference in the mean aorta, left atrium, end-diastolic diameter, interventricular septum and ejection fraction, respectively, among the study groups ( p < 0.05) (Table 6). Discussion The mean ages of the three groups were 34.43 ± 9.49 years (HIV-positive, HAART-naïve), 35.85 ± 8.94 years (HIV-positive patients on HAART) and 35.76 ± 9.74 years (controls). Similar findings have been documented in a recent study done in a similar population 24 and in other related studies. 12,25 A higher number of HIV-infected patients (70) were within the age group of 31–35 years and this represents the global age distribution in which most of the people infected with HIV/AIDS are within the sexually active age bracket of 15–35 years. 26 Clinical features of HIV 21,27 and immunosuppression were more prevalent in the HIV-positive, HAART-naïve group compared to the group of HIV-positive patients on HAART in Table 3. Proportions of HAART received by the treated group First-line drugs Second-line drugs ZDV + 3TC + EFV TDF + 3TC or FTC + ATV/r or LPVr OR OR If d4T or AZT used in first-line therapy AZT + 3TC + ATV/r or LPVr. ZDV + 3TC + NVP If TDF used in first-line therapy ZDV, Zidovudine; 3TC, Lamivudine; EFV, Efavirenz; NVP, Nevirapine; TDF, Tenofovir; FTC, Emtricitabine; ATV/r, Atazanavir/ritonavir; LPV/r, Lopinavir/ ritonavir; d4T, Stavudine; AZT, Zidovudine. Table 4. Clinical features in the study population Parameters HIV+ on HAART ( n ) HIV+ HAART- naïve ( n ) 2 χ 2 p -value Weight loss 12 49 32.292 < 0.001 Skin lesion 2 14 9.783 0.002 Pruritus 1 0 1.005 0.316 Hepatomegally 1 0 1.005 0.316 Palpitation 5 8 0.740 0.390 Breathlessness 3 3 0.000 1.000 Weakness 5 35 14.559 < 0.001 Fever 4 8 1.418 0.234 Diarrhoea 3 7 1.684 0.194 Cough 2 6 2.083 0.149 Oral thrush 1 10 7.792 0.005 Peripheral lymph node enlargement 1 10 7.792 0.005 Table 5. ECG abnormalities in the study groups and controls ECG abnormalities HIV+ on HAART HIV+ HAART-naïve Controls χ 2 p -value LAD 15 10 8 2.656 0.265 T-wave inversion leads VI–VIII 44 22 14 24.682 < 0.001 Low-voltage complex 1 0 0 2.007 0.367 1st-degree heart block 3 1 2 1.020 0.600 T-wave inversion leads II, III aVF (inferior leads) 2 1 6 4.811 0.090 VEB 0 1 0 2.007 0.367 T-wave inversion leads I, avL, V5–V6 0 2 2 2.027 0.363 LBBB 1 0 0 2.007 0.367 RBBB 1 0 2 2.020 0.364 LVH 0 8 0 16.438 < 0.001 Tachycardia 0 1 2 2.020 0.364 ST-segment elevation 0 2 0 4.027 0.134 Bradycardia 0 0 12 25.000 < 0.001 Mean QTc, mean ± SD 0.42 ± 0.04 0.41 ± 0.04 0.39 ± 0.03 Prolonged QTc, n (%) 17 (18.2) 12 (16.4) 4 (10.5) 8.784 0.012 Total, n (%) 93 (100) 73 (100) 38 (100) For QTc, F = 15.779; p < 0.001. Duncan’s post hoc multiple comparisons 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.