Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017 318 AFRICA
lower than the 48% found in our study. In their study, AIDS
patients were evaluated, while in ours, it was treatment-naïve
HIV-positive patients. This could, perhaps, account for the
differences in the prevalence observed.
Although QTC prolongation and torsades de pointes are
known to occur with pentamidine therapy,28 none of the patients
in our study was on pentamidine. Our study also showed
that among subjects who did not have hypocalcaemia, QTC
prolongation was observed more in HIV-positive patients than
in HIV-negative controls. The QTC prolongation in this study
may therefore have been due to non-specific ECG abnormalities
found in HIV-positive patients.29
In the present study, 30% of the treatment-naïve HIV-positive
patients had ST-segment depression while 21.6% had T-wave
inversion. Non-specific ST and T-wave changes on ECG are seen
in AIDS patients, caused either by pericardial disease or dilated
cardiomyopathy, which are known to occur in HIV-positive
patients.29,30
Low-voltage QRS complexes in all the leads may have been
due to pericardial effusion. Pericardial effusion has been reported
as the commonest cardiac manifestation of HIV infection.15 Low
QRS complexes in only the limb leads are a feature of dilated
cardiomyopathy.
Other ECG abnormalities found in this study were atrial
and ventricular ectopics. Although the prevalence of these
ectopics did not differ significantly between the treatment-
naïve HIV-positive patients and the HIV-negative subjects,
these premature contractions could be explained by possible
myocarditis, abnormalities in the conduction system and
derangement of the autonomic nervous system, which are all
known to occur in these patients.
Conclusion
Cardiac and non-cardiac abnormalities, detectable by ECG, 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
this group of patients at onset for cardiac and non-cardiac
abnormalities detectable by ECG. Further research could explore
how some of these abnormalities are generated in HIV infection.
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