CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
90
AFRICA
Echocardiographic diagnoses in HIV-infected patients
presenting with cardiac symptoms at Muhimbili National
Hospital in Dar es Salaam, Tanzania
PILLY CHILLO, MUHAMMAD BAKARI, JOHNSON LWAKATARE
Abstract
Objective:
To determine the pattern of echocardiographic
diagnoses in HIV-infected patients presenting with cardiac
symptoms at Muhimbili National Hospital in Dar es Salaam,
Tanzania.
Methods:
Patients known to be HIV positive and with cardiac
complaints were prospectively recruited from the Hospital’s
care and treatment centre as well as from the medical wards.
Clinical assessment, laboratory tests and echocardiography
were performed.
Results:
A total of 102 patients were recruited fromSeptember
2009 to April 2010. The patients’ mean age was 42.4 years
and 68.6% were women. The most common diagnosis was
pericardial effusion present in 41.2% of the patients. The
effusion was large in 5.9% and small in 35.3% of the patients.
Hypertensive heart disease was diagnosed in 34.3%, while
pulmonary hypertension and dilated cardiomyopathy were
present in 12.7 and 9.8%, respectively.
Conclusion:
Cardiac abnormalities are common in
HIV-infected patients, particularly when they present with
symptoms.
Keywords:
HIV and cardiac symptoms, echocardiographic
diagnoses in HIV
Submitted 17/1/11, accepted 21/9/11
Cardiovasc J Afr
2012;
23
: 90–97
DOI: 10.5830/CVJA-2011-060
Infection with the human immunodeficiency virus (HIV) is
known to cause various cardiac abnormalities as a consequence
of the direct viral effect on cardiac tissue
1
or opportunistic
diseases.
2
Furthermore, the improved survival and ageing of
HIV-infected patients following the use of highly active antiretro-
viral therapy (HAART) has been associated with the presentation
of chronic late complications, including heart diseases.
3
Studies from the pre-HAART era documented a predomi-
nance of infectious conditions and cardiomyopathies as the
main aspects of cardiac involvement in HIV-infected patients.
4-6
However, recent publications, mainly from Europe and North
America, have reported an increase in prevalence of cardiovas-
cular risk factors in HIV-infected patients on HAART, ranging
from increased prevalence of hypertension and deranged choles-
terol profiles to impaired glucose tolerance.
7,8
This increased
prevalence of traditional cardiovascular risk factors among
HIV-infected patients may have an impact on the pattern of
cardiac diseases with which these patients will present.
In sub-Saharan Africa, several studies have been carried
out to determine the prevalence of cardiac diseases among
HIV-infected patients. Twagirumukiza
et al
. found the prevalence
of dilated cardiomyopathy to be 17.7% in a fairly large sample
of 416 HIV-infected patients.
9
In a review by Magula
et al
.,
cardiomyopathy and pericardial diseases were reported as the
commonest cardiac involvements among HIV-infected patients
in Africa.
10
In Tanzania, previous studies on cardiac involvement in
HIV-infected patients were carried out in the pre-HAART
era.
4,11
Data are lacking on the pattern of cardiac involvement in
HIV-infected patients in this new era of HAART. The aim of the
present study was therefore to determine the pattern of cardiac
abnormalities among HIV-infected patients presenting with cardi-
ac symptoms at Muhimbili National Hospital in Dar es Salaam,
which is the only tertiary referral health facility in Tanzania.
Methods
This was a cross-sectional, hospital-based study conducted at
Muhimbili National Hospital between September 2009 and April
2010. Patients were prospectively recruited from the Hospital’s
outpatient care and treatment centre (CTC), as well as from the
medical wards.
Patients known to be HIV positive and presenting with any
of the following complaints: palpitations, shortness of breath
(SOB), orthopnoea, paroxysmal nocturnal dyspnoea (PND),
oedema of the lower limbs, cough (thought to be of cardiac
origin) and non-pleuritic chest pain, were consecutively recruit-
ed. Patients were excluded if they were under 18 years old and if
they did not consent to participate.
All participating patients signed a written consent form. The
study received ethical approval from the local institutional ethi-
cal review board, referred to as the MUHAS’s Senate Research
and Publications Committee.
In order to detect a 25% difference between patients with a
CD
4
+
cell count
<
100 cells/
µ
l and those with a cell count
≥
100
cells/
µ
l at a 5% significance level and 80% power, a minimum of
90 patients was required.
12
This was based on previous findings
that cardiac diseases occurred in 31% of patients with a CD
4
+
cell count
<
100 and in 6% in those whose CD
4
+
cell count was
≥
100 cells/
µ
l.
13
A structured questionnaire was used to collect socio-demo-
graphic characteristics, other cardiovascular risk factors, and
history of antiretroviral drugs used. Height and weight measure-
ments were recorded and were used to determine body mass
index (BMI). Blood pressure was taken using a mercury sphyg-
momanometer; a set of three readings, and the average of the
Muhimbili National Hospital and Muhimbili University of
Health and Allied Sciences, Dar es Salaam, Tanzania
PILLY CHILLO, MD,
MUHAMMAD BAKARI, MD, PhD
JOHNSON LWAKATARE, MBCHB, MRCP
