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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
AFRICA
315
Electrocardiographic abnormalities in treatment-naïve
HIV subjects in south-east Nigeria
Innocent Chukwuemeka Okoye, Ernest Ndukaife Anyabolu
Abstract
Background:
Cardiac complications of human immunodefi-
ciency virus (HIV) infection are important causes of morbid-
ity and mortality. We set out to determine the electrocardio-
graphic (ECG) abnormalities in treatment-naïve HIV-positive
patients in Enugu, south-east Nigeria.
Methods:
This was a cross-sectional study involving 250
HIV-positive and 200 HIV-negative subjects. Demographic
and anthropometric data, relevant investigations and ECG
results were compared between the groups.
Results:
An abnormal ECG was present in 70% of the
HIV-positive patients, sinus bradycardia in 64%, QTC prolon-
gation in 48%, T-wave inversion in 21.6%, Wolf–Parkinson–
White syndrome in 0.8%, abnormal P waves in 12.8%, 1st
degree heart block in 2.4%, ST depression in 30%, and
left-axis deviation in 1.6%. Underweight was associated with
ECG abnormalities (
p
=
0.001). The HIV-positive patients
had more ECG abnormalities than the HIV-negative subjects
(
p
=
0.001).
Conclusion:
Electrocardiographic abnormalities were common
in treatment-naïve HIV-positive patients in Enugu, Nigeria.
The 70% prevalence of ECG abnormalities in treatment-naïve
HIV-positive patients was high. There is a need to evaluate
HIV-positive patients at onset for cardiac and non-cardiac
abnormalities detectable by ECG.
Keywords:
ECG, cardiac abnormalities, non-cardiac ECG abnor-
malities, HIV, Enugu, Nigeria
Submitted 22/6/16, accepted 26/1/17
Published online 24/3/17
Cardiovasc J Afr
2017; 28: 315–318
www.cvja.co.zaDOI: 10.5830/CVJA-2017-013
About 70% of the world’s human immunodeficiency virus
(HIV)-infected persons live in sub-Saharan Africa.
1
In Nigeria,
the prevalence of HIV infection is 3.7%.
1
Cardiac lesions have been reported in HIV-positive patients.
2,3
Mpiko and Hakim showed that among the peculiar features of
HIV-related cardiovascular disorders in sub-Saharan Africans,
pericardial effusion may be the first manifestation of the
illness. Prevalent infectious diseases were seemingly mirrored
by the aetiology of cardiac disease, and specific cardiovascular
disorders were associated with HIV infection.
4
Electrocardiographic (ECG) and echocardiography abnor-
malities have been demonstrated in HIV-positive patients.
2,3,5-7
The ECG abnormalities documented include arrhythmias,
low-voltage QRS complexes, non-specific ST-segment and
T-wave changes, poor R-wave progression, right bundle branch
block, axis deviations, enlargement of various heart chambers
and QTC prolongation.
8,9
The manifestations of HIV infection in
organs other than the heart mask the clinical evidence of cardiac
disease in these subjects.
10-13
Electrocardiography is effectively used to detect cardiac
diseases.
14
Cardiac diseases attributable to HIV infection are of
public health importance because they are usually silent, yet have
the potential to cause high mortality rates.
There is a paucity of studies on ECG abnormalities in
treatment-naïve HIV-positive patients emanating from south-
east Nigeria, prompting us to embark on this study. This will
help in identifying HIV-positive patients who may have cardiac
and non-cardiac illnesses, detectable by ECG, with a view to
instituting appropriate early interventions to whittle down
adverse outcomes in this group of patients. In addition, ECG is
cheap and readily available.
Methods
This was a cross-sectional study conducted at the University of
Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between
September and December 2015. The study subjects consisted of
250 treatment-naïve HIV-positive patients and 200 HIV-negative
subjects as controls, consecutively recruited from an HIV clinic
and the medical wards of the hospital.
Inclusion criteria were subjects with confirmed HIV-positive
tests, aged 15 years andolder. Those subjectswhohadhypertension,
pre-morbid cardiac diseases, a history of cigarette smoking and
significant alcohol use, those on medications known to affect the
cardiovascular system, pregnant women and puerperal women
up to three months, those with diabetes mellitus, acromegaly or
thyrotoxicosis were all excluded from the study.
Informed consent was obtained from all the subjects who
participated in this study. The ethics committee of UNTH
approved the study.
Demographic and other relevant data were obtained with
the help of a questionnaire. Physical examination was done
on each subject. Anthropometric data were obtained: height
(m) and weight (kg). Body mass index (BMI) was recorded as
weight/height
2
(kg/m
2
). Blood pressure (mmHg) was measured,
systolic blood pressure (SBP) at Korotkoff phase 1 and diastolic
blood pressure (DBP) at phase 5 or at phase 4 when the
differences between phase 4 and 5 were more than 10–20 mmHg.
Body temperature (°C) was taken and evidence of cardiac
decompensation determined.
Chukwuemeka Odumegwu Ojukwu University, Awka, Nigeria
Innocent Chukwuemeka Okoye, MB BS, FWACP
Imo State University, Orlu, Nigeria
Ernest Ndukaife Anyabolu, MB BS, FMCP,
enhealer@yahoo.com