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

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 324 AFRICA inflammation and myocarditis. 43 This is corroborated by the postulation of immune dysfunction, as measured by the CD4 nadir, which is an independent risk factor for increased left ventricular mass, LVH and dysfunction. 44-46 The HAART-naïve group consisted of more immunosuppressed subjects with a CD4 nadir and HIV viraemia, compared to the HAART-exposed subjects (Fig. 2). ECG findings in this study showed a relatively high prevalence of LVH in the HIV-positive, HAART-naïve patients, compared to it not being seen in subjects on HAART (Table 5), as assessed by the voltage criteria of Sokolow and Lyon, and Araoye. 47,48 Heart rate and left ventricular ejection fraction (LVEF) were higher in the HIV-positive, HAART-naïve subjects compared to the controls and HIV-positive, HAART-exposed subjects in this study (Tables 1, 6). This could have been due to increased prevalence of opportunistic infections, fever, anaemia, diarrhoea and dehydration, which would drive increased sympathetic activity and cardiac contractility in many of the individuals in this study group. 16 Hyperdynamic left ventricular performance with enhanced contractility was reported in this subgroup of patients by Lipshultz et al . 49 In a recent study done in a similar population, there was no statistically significant difference in LVEF in the two HIV-positive groups but LVEF was slightly higher in subjects who were on PI-based HAART. 24 However, duration of PI use and clinical characteristics of the study population were not stated. A limitation of the study is the relatively short duration of the use of PI and HAART, which have been found to cause diabetes mellitus and dyslipidaemia, which in turn have been identified to cause cardiovascular disease among HIV patients. Conclusion In this study, clinical features of HIV infection, immuno- suppression and reduced CD4 cell count were more prevalent in HIV-positive patients who were HAART-naïve than in HIV-positive patients on HAART. The dimensions of the aortic root, left atrium and left ventricle were within normal limits but relatively larger in the HIV-positive, HAART-exposed group, while the wall thickness and LVEFwere higher in the HIV-positive, HAART-naïve subjects. A longitudinal study would help identify possible links in the use of antiretroviral therapy. We acknowledge the staff of the HIV clinic at the University of Nigeria Teaching Hospital, Enugu, for their support during the study. We thank the patients and control subjects for volunteering in the study. References 1. UNAIDS. Press release: new survey results indicate that Nigeria has an HIV prevalence of 1.4%.Availableat :https://www.unaids.org/en/resourc- es/presscentre/pressreleaseandstatementarchive/2019/march/20190314_ nigeria. 2. The United States President’s Emergency Plan for AIDS Relief 2019 Annual Report to Congress. https://www.state.gov/wp-content/ uploads/2019/09/PEPFAR2019ARC.pdf. 3. Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, et al . Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 2006; 41 : 194–200. 4. Hooshyar D, Hanson DL, Wolfe M, Selik RM, Buskin SE, McNaghten AD, et al . Trends in perimortal conditions and mortality rates among HIV-infected patients. AIDS 2007; 21 : 2093–2100. 5. Ntsekhe M, Hakim J. Impact of human immunodeficiency virus infection on cardiovascular disease in Africa. Circulation 2005; 112 : 3602–3607. 6. Thiebaut R, Dabis F, Malvy D, Jacqmin-Gadda H, Mercie P, Valentin VD. Serum triglycerides, HIV infection, and highly active antiret- roviral therapy, Aquitaine Cohort, France, 1996 to 1998. Groupe d’Epidemiologie Clinique du Sida en Aquitaine (GECSA). J Acquir Immune Defic Syndr 2000; 23 : 261–265. 7. Henry K, Melroe H, Huebsch J, Hermundson J, Levine C, Swensen L. Severe premature coronary artery disease with protease inhibitor. Lancet 1998: 351 : 13–28. 8. Animasahun BA, Diaku-Akinwumi IN, Ubuane PO, Ibitoye E. Cardiac Table 7. Comparison of main findings with other similar studies Studies ECG abnormalities Echocardiography: wall thickness Echocardiography: mean chamber dimensions and LVEF Index study ECG abnormalities were higher in HAART- exposed (93%), and HAART-naïve (73%), compared to controls (38%). LVH was found in 11% of HAART-naïve cases but none in the HAART-exposed and controls Mean thickness of IV septum was higher in the HAART-naïve but similar between HAART-exposed and controls. LVM and LVMI were higher in cases than controls Aortic root, LA and LV were slightly higher in HAART-exposed than HAART-naïve and controls. LVEF was higher in cases (HAART-naïve, 72.8%, and HAART-exposed, 68.9%) compared to the controls (67.3%) Ajala et al . 24 ECG abnormalities were higher in cases (49%) than controls (42%) IV septum was slightly higher in controls than cases but LVM and LVMI were higher in cases than controls LA was slightly higher in cases than controls Aortic root was slightly higher in controls than cases. The mean LVEF was higher in the cases (71.9%) compared to controls (68.9%) Ogunmodede et al . 12 ECG abnormalities were more in HIV-positive patients (55.3%) than controls (2.7%) LVH was higher in cases (17.3%), than controls (4%) IV septum, LVM and LVMI were higher in cases than controls LV was slightly higher in cases than controls. LA was slightly higher in controls. LVEF not stated Uwanuruochi et al . 16 Not stated IV septum and LVMI were higher in cases than controls. PW slightly higher in controls than cases LV was slightly higher in controls. LVEF was higher in cases (60.3%) than controls (57.9%) Danbauchi et al. 20 Not stated IV septum, PW, LVM and LVMI were higher in cases than controls Aortic root, LA and LV were higher in cases The LVEF was the same in both the cases and controls (66%) Reinsch et al . 14 Not stated IV septum and PW were higher in 18 and 11% of cases, respectively LV was higher in 10.% of cases LVEF was 57.5% LVH, left ventricular hypertrophy; IV, interventricular; LA, left atrium; LV, left ventricle; LVM, left ventricular mass; LVMI, left ventricular mass index; LVEF, left ventricular ejection fraction; PW, posterior wall.