Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 321 and 100 controls with HIV-negative serology were recruited for comparison. Antiretroviral therapy was commenced according to Nigerian guidelines for HIV and AIDS treatment and care. 21 The controls were recruited from subjects being screened for marriage, blood donation and insurance purposes. We excluded patients in end-stage AIDS disease, classified as category C by the Centre for Disease Control, 1993. 22 Also excluded were those less than 18 years of age and subjects with a history or laboratory evidence of arterial hypertension, coronary artery or ischaemic heart disease, congestive heart failure, cardiomyopathy, peripheral or cerebrovascular disease and diabetes mellitus. In addition, pregnant women or those in pueperium, those with a significant history of tobacco and/or alcohol use, as well as those who used drugs known to affect the cardiovascular system were excluded. Clinical evaluation was carried out on every subject. Their anthropometric parameters such as height (m) and weight (kg) were measured, while body mass index (BMI) (kg/m 2 ) and body surface area (m 2 ) were calculated. A resting 12-lead surface electrocardiogram (ECG) was done on all recruited subjects in the supine position, at a speed of 25 mm/s, using a two-channel automated Techmel ECG machine (USA), ECG-1101 model. Analysis of the ECG tracings from each participant was done in the standard fashion, and long-lead II tracing was used as the rhythm strip. Parameters analysed were heart rate, rhythm, P wave (duration, shape), height (paroxysmal atrial complexes), PR interval, QRS wave (duration, shape, height, axis), paroxysmal ventricular complexes, QT interval, QTc, Q wave, T wave (shape), ST-segment (shape), and R and S waves for ventricular hypertrophy. Resting two-dimensional echocardiography was carried out on all subjects using the SonoScape SS1-5000 machine and transducer of frequency 3.5 MHz. M-mode, two-dimensional, pulsed-wave, continuous-wave, tissue Doppler imaging and colour Doppler assessments were carried out on each subject in the left lateral decubitus position. Measzurements were taken (in cm) using the American Society of Echocardiography guidelines (leading-edge methodology). 23 Statistical analysis Data were analysed using EPI INFO version 6 software. Association between categorical variables was done using the chi-squared test. The Student’s t -test was used to compare means of normally distributed continuous variables while the Mann– Whitney U -test was used to compare median of skewed data. The means ± standard deviations of parameters across the three groups were compared using one-way ANOVA, and the Duncan post hoc multiple comparisons test was done to indicate means for groups in homogenous subsets (means not significantly different). A p -value < 0.05 was taken as statistically significant. Results There was a significant difference in the mean weight, height, BMI and heart rate among the study groups ( p < 0.05) (Table 1). The mean age for HIV-positive, HAART-naïve patients was 34.43 ± 9.49 years with a range of 18–59, while that for HIV-positive patients on HAART was 35.85 ± 8.94 years with a range of 23–59, and that for the controls was 35.76 ± 9.74 years with a range of 18–57 years. The highest number of subjects (70) was from the age bracket 31–35 years, while the least number (21) was from the age group above 50 years (Table 2, Fig. 1). There were 51 HIV-positive patients on HAART, 48 HIV-positive, HAART-naïve patients and 52 controls ( p > 0.841). The median time from diagnosis of HIV for HIV-positive, HAART-naïve patients was one year with minimum and maximum durations of one and 21 years, respectively, while that for HIV-positive patients on HAART was three years with minimum and maximum durations of one and 13 years, respectively. This was statistically significant ( U = 2 144, p < 0.001). The types of HAART received by the treated group were the non-nucleoside reverse-transcriptase inhibitors (NNRTIs), namely Nevirapine (NVP) 200 mg BD, Efavirenz (EFV) 600 mg OD; nucleoside reverse-transcriptase inhibitors (NRTIs), namely Zidovudine (ZDV) 250 mg BD, Lamivudine (3TC) 150 mg BD, Stavudine (d4T) 30 mg BD, Tenofovir (TDF) 300 mg OD; and the protease inhibitors, namely Retinovir (RTV) 100 mg BD, Table 1. Comparison of some demographic parameters across the three groups using one-way ANOVA Param- eters HIV+ on HAART HIV+ HAART-naïve Controls F -value p -value Age 35.85 ± 8.94 34.43 ± 9.49 35.76 ± 9.74 0.716 0.490 Weight 65.77 ± 13.92* 62.40 ± 12.45 68.69 ± 8.67* 7.007 0.001 BMI HR 24.14 ± 4.55* 82.92 ± 14.08* 22.47 ± 3.65 84.28 ± 16.79* 24.18 ± 3.32* 68.77 ± 8.02 6.301 40.232 0.002 < 0.001 *Duncan’s post hoc multiple comparisons test indicating means for groups in homogenous subsets (means not significantly different). BMI: body mass index; HR: heart rate. Table 2. Demographic characteristics of the study participants Parameters HIV+ on HAART HIV+ HAART-naïve Control F -value p -value Gender Male 51 48 52 0.347 0.841 Female 49 52 48 Age group, years < 26 11 19 16 6.058 0.913 26–30 22 19 17 31–35 21 24 25 36–40 17 16 15 41–45 13 7 8 46–50 9 9 11 > 50 7 6 8 30 25 20 15 10 5 0 < 26 HIV +ve on HAART HIV +ve HAART-naÏve HIV –ve control 26–30 31–35 36–40 41–45 46–50 > 50 No of subjects Fig. 1. Age distribution of the study groups.