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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 4, July/August 2020
190
AFRICA
Patterns of cardiovascular risk and disease in
HIV-positive adults on anti-retroviral therapy in
Mozambique
I Dobe, N Manafe, N Majid, I Zimba, B Manuel, A Mocumbi
Abstract
Introduction:
With improved access to anti-retroviral therapy
(ART) the focus of HIV treatment is changing to reducing
chronic co-morbidities and their effects, but guidelines for
HIV care in many African countries do not include screening
for cardiac disease. Our study aimed to determine the pattern
of cardiac abnormalities in HIV-positive patients on ART.
Methods:
We implemented a prospective, observational study
for 24 months on a random sample of adult patients seen at
a dedicated HIV clinic in Mozambique. Demographic, clini-
cal and full cardiovascular evaluations were performed on all
participants.
Results:
We enrolled 264 HIV-positive patients (mean age 39.3
years; 186 female, 70.5%). The mean time on ART was 46 (SD
36) months and most had low viral load (174, 65%). Obesity
(45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and
severe anaemia (21, 8.3%) were frequent. Diabetes was present
in four patients (1.5%). The most important conditions in 252
patients submitted to echocardiography (88, 34.9% had cardiac
abnormalities) were: severe rheumatic heart valve disease
(six), severe dilated cardiomyopathy (five), aortic degenerative
disease and congenital heart disease (in three patients each). At
24-month follow up, six of the 252 patients had died; of the 196
reviewed on echocardiography 29 had progressed and two had
improved ventricular systolic function.
Conclusions:
This young cohort of HIV-positive patients on
ART showed lower occurrence of tuberculous pericarditis
and dilated cardiomyopathy but high cardiovascular risk, as
assessed by the presence of obesity, hypertension and anae-
mia. Cardiac abnormalities needing multidisciplinary care
were also found. There is a need for tailored cardiovascular
risk stratification and screening for cardiovascular disease in
HIV-positive patients on ART in Africa.
Keywords:
antiretroviral therapy, cardiovascular risk, cardiovas-
cular disease
Submitted 6/2/19, accepted 23/2/20
Published online 19/6/20
Cardiovasc J Afr
2020;
31
: 190–195
www.cvja.co.zaDOI: 10.5830/CVJA-2020-007
With improved access to anti-retroviral therapy (ART) the
focus of human immunodeficiency virus (HIV) treatment in
sub-Saharan Africa should not only be to treat acute illnesses
caused by opportunistic infections, but rather to reduce chronic
co-morbidities and their effects.
1
Mozambique, a low-income country with > 15% adult HIV
prevalence, has an aging population living with HIV and a high
prevalence of arterial hypertension with low control rates.
2,3
Concomitantly, there are other neglected cardiovascular diseases
such as tuberculous pericarditis, rheumatic heart disease (RHD)
and cardiomyopathy.
4-6
Despite the recognition of an increased cardiovascular
morbidity rate in HIV-infected patients on ART,
7,8
the national
guidelines for HIV care in Mozambique do not include screening
for cardiac disease. This is not only due to the scarcity of qualified
personnel and low access to diagnostic tools (such as rapid tests
for biomarkers and cardiac ultrasound), but is also related to
lack of awareness of the burden of cardiovascular risk factors
and disease profile in this population. We therefore designed
a study to determine the pattern of cardiac abnormalities in
asymptomatic HIV-infected individuals on ART.
Methods
We conducted a prospective, cross-sectional and hospital-based
study to assess the prevalence of cardiovascular abnormalities in
HIV-positive adults on chronic ART. The study took place from
April 2012 to March 2014 at a dedicated HIV clinic located in
Maputo, the capital city of Mozambique.
We systematically selected participants among the 2 851
HIV-infected adults registered in the dedicated HIV clinic’s
database and we invited them to participate in the study during
their typical quarterly clinical follow-up visit. After initial
random selection of the first patient among the first 10 listed for
consultation each day, we selected every 10th patient to include
in the study. We excluded pregnant woman and all those with
known heart disease.
The National Ethics Committee of Mozambique (reference
no: 230/CNBS/12) approved this study. All patients provided
written informed consent. The data obtained were treated with
strict confidentiality and data were stored in password-protected
computers accessed by only the researchers.
All patients had free access to ART and basic laboratory
work-up as per usual care in Mozambique’s public institutions.
Those participants who had cardiac abnormalities were referred
to our cardiology clinic for medical attention.
National Institute of Health, Mozambique
I Dobe, MD
N Manafe, MD, MSc
A Mocumbi, MD, PhD,
amocumbi@gmail.comEduardo Mondlane University, Maputo, Mozambique
B Manuel, MD, MSc
A Mocumbi, MD, PhD
Centro Dream St Egidio, Maputo, Mozambique
N Majid, MD, PhD
I Zimba, MD