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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
AFRICA
317
<
0.001). However, among the 160 HIV-positive patients with
tachycardia, 40 (25.0%) had fever, while 120 (75.0%) did not
have fever. By contrast, among the 24 HIV-negative subjects
with tachycardia, 19 (79.2%) had fever while five (20.8%) did
not. When fever was excluded, the prevalence of tachycardia
was significantly higher in the HIV-positive patients than the
HIV-negative controls.
The mean axis was 45.64
±
6.22° in the treatment-naïve
HIV-positive subjects. One subject has left-axis deviation of –30°
and three had left-axis deviation of –60°, while none had right
axis deviation.
Thirty-two (12.8%) of the 250 treatment-naïve HIV-positive
subjects had abnormal P waves with P mitral in lead II with or
without biphasic P wave in lead VI. By contrast, this was seen in
16 (8.0%) of the HIV-negative subjects.
The mean PR interval was 0.16
±
0.03 seconds in the
treatment-naïve HIV-positive patients. Six subjects had
prolonged PR intervals (1st degree heart block), while two
had shortened PR intervals with associated delta waves and
widened QRS complexes, evidence of Wolf–Parkinson–White
(WPW) syndrome. No abnormal PR interval was seen in the
HIV-negative subjects.
The mean QRS duration was 0.07
±
0.01 seconds. The two
subjects with QRS > 0.01 seconds were the same patients that
had WPW syndrome stated above.
Thirty per cent of the subjects had ST depression in two or
more leads. There was no ST elevation in either group.
T-wave inversion was present in 54 (21.6%) of the 250
treatment-naïve HIV-positive subjects. Sixteen (8%) of the
HIV-negative subjects had inverted T waves.
The mean QTC interval was 0.44
±
0.03 seconds in the
treatment-naïve HIV-positive subjects. Of these, 48% had
prolonged QTC intervals, compared to 8% of the HIV-negative
subjects with same QTC intervals. This difference was significant
(
p
<
0.001). Furthermore, among the subjects without
hypocalcaemia, QTC prolongation was observed more often in
the HIV-positive patients than the HIV-negative controls. This
difference was statistically significant (
p
<
0.001).
The mean serum urea level in the study group was 5.803
±
0.227 mmol/l. Sixty-four (25.6%) of the 250 HIV-positive
patients had a serum urea level > 6.5 mmol/l, and they had some
level of dehydration on clinical examination.
The mean serum potassium level was 3.168
±
0.167 mmol/l.
Out of the 250 treatment-naïve HIV-positive patients, 150 (60%)
had serum potassium levels
<
3.5mmol/l, while none had serum
potassium levels ≥ 5.5 mmol/l.
The mean serum calcium level in the study group was 2.06
±
0.133 mmol/l. Hypocalcaemia was observed in 25% of the
treatment-naïve HIV-positive patients. Forty-six per cent of the
patients had hypoalbuminaemia (albumin
<
2.8 g/dl).
One hundred and twenty (48%) of the treatment-naïve
HIV-positive patients had diarrhoea.
Discussion
The prevalence of ECG abnormalities in HIV-positive patients
at UNTH (70%) was significantly higher, compared to the 35%
in HIV-negative subjects. This was similar to the 86% reported
by Mounodji
et al.
in Chad,
8
but higher than the 53% seen by
Levy
et al
. in Washington, USA,
15
and the 55% reported by Herst
et al
. in Ontario, Canada.
16
These observed differences could
be explained by the differences in the study design; the study
population was 250 in our study, 32 in the study by Mounodji
et
al.
, and 21 in the study by Levy
et al
. In addition, only patients
with Kaposi sarcoma were evaluated in the latter study. Cardiac
abnormalities in HIV-positive patients were reported based on
either autopsy findings or more advanced cardiac investigations
such as echocardiography and Doppler studies. Nevertheless, the
prevalence rate of ECG abnormalities in our study was within
the general prevalence rate of 28 and 73% documented in some
studies.
3,8,16,17
The cachectic heart, a clinical pathological and ECG entity
seen in chronic debilitating diseases, has been reported in
HIV-positive patients.
18-20
In our study, 48%of the treatment-naïve
HIV-positive patients had lowBMI, and ECG abnormalities were
found in 80% of those patients with a low BMI (underweight).
We also demonstrated that BMI had a significant effect on
ECG abnormalities (
p
<
0.001). This shows that the ECG
abnormalities observed in our study may have been contributed
to by the low BMI, among various mechanisms elucidated in the
pathogenesis.
21,22
The prevalence of the various ECG abnormalities seen in
HIV-positive patients at UNTH was in order of frequency: sinus
tachycardia (64%), prolonged QTC (48%) and T-wave inversion
(21.6%). This compares favourably with a similar study by Sani
in Jos, Nigeria.
23
Mounodji
et al
. reported sinus tachycardia in
31% of 55 patients studied in Chad.
7
Sinus tachycardia was the
second commonest ECG abnormality after low-voltage QRS
complexes in their series.
Heart rate is known to increasewitha rise inbody temperature.
24
When fever was excluded in this study and tachycardia was
compared between the treatment-naïve HIV-positive patients
and the HIV-negative controls, the difference was statistically
significant (
p
<
0.001). This shows that the tachycardia we
noted could not be explained by pyrexia, which some of the
patients had. Unexplained fever is a feature of myocarditis, and
myocarditis can be caused by HIV infection.
4
Some workers, however, view tachycardia as being due to
excessive sympathetic stimulation, which could be caused by
autonomic imbalance or stimulation of beta-receptors by the gp
120 protein of HIV.
25
Emotion may be an additional contributory
factor.
26
However, dehydration and underweight, measures of
malnutrition in developing countries, could also explain, in part,
the sinus tachycardia observed in our study.
QTC prolongation with no known cause was reported in
69% of AIDS patients studied by Kocheril
et al
.
27
This rate is
Table 4. Comparison of ECG parameters between treatment-naïve
HIV-positive patients and HIV-negative subjects
Parameter
Group Sample size Mean
SD p-value
Heart rate (beats/min)
HIV+
HIV–
250
200
99.6
84.36
11.53
5.35
<
0.001
Axis (degrees)
HIV+
HIV–
250
200
45.64
31.38
61.23
11.78
<
0.001
PR interval (s)
HIV+
HIV–
250
200
0.16
0.14
0.03
0.01
<
0.001
QRS duration (s)
HIV+
HIV–
250
200
0.07
0.06
0.04
0.01
0.068
QTC
HIV+
HIV–
250
200
0.44
0.39
0.03
0.01
<
0.001
SD
=
standard deviation