Cardiovascular Journal of Africa: Vol 27 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016 AFRICA 27
count (in the AIDS group) demonstrated a negative correlation.
Multiple linear regression analysis of factors that correlated
significantly with LVSD revealed that age and CD4+ cell count
were the best predictors of LVSD in our children who were
HIV positive and in those with AIDS (p = 0.025 and 0.038,
respectively) (Table 4).
Discussion
LVSD was more prevalent in the AIDS group (81.2%), than
in the HIV group (27.0%) (p = 0.03). This is higher than the
previous prevalences of 33.7% reported by Okoroma et al.8 in
Lagos, Nigeria; 22% reported by Uwanuruochi15 in Enugu (in
an adult population); and 29% reported by Lipshultz et al .16
in Boston. Other workers have reported wide-ranging figures
for systolic dysfunction, such as the 6.5% prevalence noted by
Cardoso et al.9 in Paris and 85.7% prevalence among adults
reported by Longo-Mbenza1 in Kinshasa.
These observed differences in prevalence may have been
due to the use of different criteria for the definition of cardiac
abnormality, or methodological differences, including study
design, sample size, patient selection method, focus on a single
echocardiographic parameter and bias in patient selection in
terms of inadequate matching for age and gender.17 However,
these observed differences may also show that there is some racial
or genetic predisposition to this detectable cardiac abnormality. 18
In a multicentre, prospective cohort study conducted in the USA,
the significance of a high prevalence of systolic dysfunction
related to its association with mortality.19
The prevalence of cardiac dysfunction is high in African
children with HIV/AIDS but this has not attracted much
attention.8 This is partly because the clinical picture of HIV/
AIDS is still dominated by chronic diarrhoea from opportunistic
infections, and severe malnutrition.20 Cardiac dysfunction is rarely
diagnosed in HIV-infected children in our setting and standard
care does not include echocardiography.8 Echocardiography is
a non-invasive and valuable means of characterising cardiac
abnormalities.
The mean weight and BMI in the AIDS group in our study
was significantly lower than in the controls. This was expected as
the loss of lean body mass, especially muscle protein, has been
well documented in patients with HIV infection.21-23 Heart rate
was significantly higher in the HIV and AIDS groups compared
with the controls. Okeahialam et al. from Jos, Nigeria, noted this
in 2000,24 and Coudray et al.25 reported similar findings in France.
Table 1. Demographic and clinical characteristics of patients and controls
Variable
HIV infection
(n = 74)
AIDS
(n = 16)
Control
(n = 90) F/χ2 p-value
Gender
Male 38 9 49 0.654 0.06
Female 36 7 41
Mean age (years) 8.15 ± 3.08 7.9 ± 2.07 8.3 ± 3.04 0.14 0.87
Mean weight
(kg)
14.43 ± 9.67 10.22 ± 6.07 22.4 ± 9.42 21.30 < 0.001
Mean height
(cm)
108.1 ± 20.9 95.7 ± 15.3 114.7 ± 21.8 6.28 0.002
Mean BMI for age
2–4 years (M)
(F)
18.3 ± 2
18.8 ± 1
16.4 ± 2
16 ± 2
22 ± 3.1
22.5 ± 2.1
337.81 < 0.001
5–9 years (M)
(F)
16.7 ± 1
16.3 ± 1.2
15.8 ± 1.2
15.5 ± 1.5
23.2 ± 2.9
23.5 ± 2.4
240.08 < 0.001
10–14 years (M)
(F)
17.5 ± 0.8
17.1 ± 0.9
16.3 ± 2
16.3 ± 0.5
21.5 ± 2
20.4 ± 3
94.11 < 0.001
Mean RR/min 29 ± 5 32 ± 6 26 ± 5 13.12 < 0.001
Mean HR/min 103 ± 18 120 ± 20 92 ± 13 25.05 < 0.001
Mean SBP
(mmHg)
89 ± 8 81 ± 12 85 ± 12 5.14 0.007
Mean DBP
(mmHg)
52 ± 8 60 ± 7 54 ± 7 7.76 0.001
Mean Hb (g/dl) 9.8 ± 1.1 8.6 ± 0.7 11.6 ± 0.7 127.93 < 0.001
Mean WBC
(cells/µl)
6813 ± 2056.3 4059 ± 1838.2 5059 ± 1838.2 23.02 < 0.001
Mean ESR
(mm/1st h)
31 ± 10.6 67 ± 12.4 6.3 ± 2.4 486.40 < 0.001
Mean CD4+
(cell/mm3)
1486.6 ± 158.6 504.6 ± 300.3 1786.6 ± 1582.6 8.93 < 0.001
CD4+ (cell/mm3)
≤ 1499, n (%) 6 (8.1) 15 (93) 30 (3.3) 5.6 0.01
≥ 1500, n (%) 68 (92) 1.1 (6.9) 87 (96) 4.54 0.05
BMI: body mass index, RR: respiratory rate, HR: heart rate, SBP: systolic blood
pressure, DBP: diastolic blood pressure, Hb: haemoglobin, WBC: white blood cells,
ESR: erythrocyte sedimentation rate.
Table 2. Left ventricular echocardiography
characteristics of the study participants
Variable
HIV
infection
(n = 74)
AIDS
(n = 16)
Control
(n = 90) F p-value
Mean LVMI (g/m2 ) 90.4 ± 25.3 89.4 ± 25.1 74.5 ± 23.2 9.47 < 0.001
Mean % FS 35.3 ± 10.5 31.6 ± 9.5 39 ± 5.2 7.75 0.001
Mean % EF 53.3 ± 15.7 45.3 ± 12.7 68.1 ± 12.4 39.922 < 0.001
Mean LVEDd (cm) 6.8 ± 0.6 6 ± 0.6 3.8 ± 0.7 441.89 < 0.001
Mean LVESd (cm) 2.7 ± 0.2 3.8 ± 0.4 2.2 ± 0.2 375.62 < 0.001
Prevalence of LVSD, n (%) 20 (27) 13 (81.2) 2 (2.2) χ2 = 1.23 0.03
LVMI: left ventricular mass index, FS: fractional shortening, EF: ejection fraction,
LVEDd: left ventricular end-diastolic dimension, LVESd: left ventricular end-
systolic dimension, LVSD: left ventricular systolic dysfunction.
Table 3. Pearson’s correlation of independent variables with LV
systolic dysfunction in HIV carriers and AIDS groups
HIV carriers AIDS
Independent variable
Correlation
coefficient
(r) p-value
Correlation
coefficient
(r) p-value
Age (years) 0.32 0.03* 0.22 0.01*
BMI for age 0.19 0.31 0.20 0.22
Duration of treatment (years) –0.49 0.01* –0.45 0.02*
SBP (mmHg) –0.29 0.12 –0.30 0.45
DBP (mmHg) –0.38 0.04* –0.35 0.53
Haemoglobin conc (g/dl) –0.20 0.30 –0.25 0.62
WBC (total) –0.01 0.95 –0.05 0.12
ESR –0.33 0.08 –0.35 0.24
CD4+ cell count 0.08 0.01* –0.09 0.02*
Stage of disease –0.05 0.32 –0.23 0.11
Pulse rate 0.13 0.04* 0.15 0.03*
Table 4. Stepwise multiple linear regressions of factors that
correlated with LV systolic dysfunction in the subjects
Model
Unstandardised
coefficients
Standardised
coefficients
(r)
Beta t-value p-value
95% CI for B
B
Std
error B
Std
error
Constant 1.282 277 4.627 0.000 0.714 1.851
Age (years) 0.005 0.051 –0.212 1.170 0.025* –0.015 0.004
CD4+ cell counts 0.034 0.016 0.396 2.186 0.038* 0.002 0.066
CI: confidence interval, dependent variable: LV systolic dysfunction, *Significant.