Volume 6, Issue 1, June 2020, Page: 15-24
Pattern of Electrocardiographic and Echocardiographic Abnormalities Among HIV Patients in Port Harcourt, Nigeria
Ajala Aisha Oluwabunmi, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port-Harcourt, Nigeria
Akpa Maclean Rumokere, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port-Harcourt, Nigeria
Dodiyi-Manuel Sotonye, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port-Harcourt, Nigeria
Received: May 6, 2020;       Accepted: May 29, 2020;       Published: Jun. 9, 2020
DOI: 10.11648/j.ijhpebs.20200601.13      View  325      Downloads  166
Infection with HIV is independently associated with an increased risk of cardiovascular disease, while therapeutic use of HAART has been shown to increase the risk of metabolic derangements which may have potentially damaging effects on the cardiovascular system. The study was carried out to assess the pattern of electrocardiographic (ECG) and echocardiographic (ECHO) abnormalities among HAART experienced and HAART naïve HIV patients. This was a cross-sectional study of one hundred (100) HIV seropositive subjects and 100 age and sex matched controls to assess cardiovascular risk among HIV seropositive persons in Port-Harcourt, Rivers State, Nigeria. The results showed that the prevalence of ECG abnormalities among the cases was 49 (49%) compared to 42 (42%) of the controls (c2=0.020, p=0.886). Sinus tachycardia was the most common ECG abnormality in all study participants and was present in 37 (37%) of the control subjects when compared to 21 (21%) of the cases and this was statistically significant. T-wave inversion and prolonged QT interval were the next two most prevalent findings seen in 23% and 18% of the cases compared with 8% and 5% of the controls respectively and these were also statistically significant (p=0.004 and 0.003 respectively). Among the cases 10% had grade 1-2 diastolic dysfunctions compared with 23% of the controls and this was statistically significant (p=0.013). Ninety percent (90%) however had normal diastolic function compared with 77% of the controls. Systolic dysfunction was found in only 2% of the HAART experienced cases compared to 10 (10%) of the HAART naïve controls and this was also statistically significant (p=0.017). The study showed that electrocardiographic and echocardiographic abnormalities are common in HIV seropositive patients with ECG abnormalities being more common among the HAART treated subjects. These ECG & ECHO abnormalities generally increase the cardiovascular risk profile of PLWHIV/AIDS and are independent predictors of CV mortality hence the need for prompt diagnosis and interventions.
HIV, HAART, Electrocardiogram, Echocardiogram
To cite this article
Ajala Aisha Oluwabunmi, Akpa Maclean Rumokere, Dodiyi-Manuel Sotonye, Pattern of Electrocardiographic and Echocardiographic Abnormalities Among HIV Patients in Port Harcourt, Nigeria, International Journal of HIV/AIDS Prevention, Education and Behavioural Science. Vol. 6, No. 1, 2020, pp. 15-24. doi: 10.11648/j.ijhpebs.20200601.13
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Amado CL, Almeida AG. Cardiovascular disease associated with Human Immunodeficiency Virus: a review. Rev Port Cardiol. 2015; 34 (7-8): 479-491.
Grinspoon SK, Grunfield C, Kotler DP, Currier JS, Lundgreen JD, Dube MP, et al. State of the science Conference Initiative to decrease cardiovascular risk and increase quality of care of patients living with HIV/AIDS: Executive summary. Circulation 2008; 118: 198-210.
Lo J, Grinspoon S. Cardiovascular disease in HIV-infected patients: does HIV infection itself increase cardiovascular risk? Curr Opin HIV/AIDS. 2008; 3 (3): 207-213.
Hescht SR, Berger M, VanTosh A, Croxson S. Unsuspected cardiac abnormalities in the Acquired Immunedeficiency Syndrome: an echocardiographic study. Chest 1989; 96: 805-808.
Reyskens PM, Essop MF. HIV protease inhibitors and onset of cardiovascular diseases: a central role for oxidative stress and dysregulation of the ubiquitin-proteasome system. Biochims Biophys Acta 2014; 1842 (2): 256-268.
Stein JH, Klein AM, Bellehumeur JL, McBride PE, Wiebe DA, Otvos JD et al. Use of Human Immunodeficiency Virus-1 Protease Inhibitors Is Associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation 2001; 104: 257-262.
Krikke M, Hoogeveen RC, Hoepelman AIM, Visseren FLJ, Arends JE. Cardiovascular risk prediction in HIV–infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD) Systemic Coronary Risk Evaluation for Netherlands (SCORE–NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D: A: D) risk prediction models. HIV Medicine 2016; 17: 289-297.
Lang RM, Bierig M, Devereux RB, FlachKampf FA, Foster E, Pelikka PA et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography. J Am Soc Echocardiogr. 2005; 18 (12): 1440-1463.
Teichholz, LE, Kreulen TH, Herman, MV, Gorlin R. Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlation in the presence of absence of asy-nergy. American Journal of Cardiology. 1976; 37 (1): 7-11.
Nagueh SF, Smiseth OA, Appleton CP, Bryd BF, Dokainish H, Edverdsen T et al. Recommendations for the evaluation of left ventricular diastolic function by Echocardiography. An update from the American Society of Echocardiography and European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277–314.
Ojikutu RK. The prevalence of cardiovascular diseases in Lagos state, Nigeria. Ghana Journal of Developmental Studies. 2009: 6 (2): 41-50.
Njoku PO, Ejim EC, Anisiuba BC, Ike SO, Onwubere BJC. Electrocardiographic findings in a cross-sectional study of Human Immunodeficiency Virus (HIV) patients in Enugu, South-East Nigeria. Cardiovasc J Afr 2016: 27: 252-257.
Okoye IC, Anyabolu NE. Electrocardiographic abnormalities among treatment-naïve HIV subjects in South-East Nigeria. Cardiovasc J Afr 2017; 28.
Soliman EZ, Prineas RJ, Roediger MP, Duprez DA, Boccara F, Boesecke C et al. Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy study. J Electrocard 2010; 44 (6) 779-785.
Kabwe L, Lakhi S, Kalinichenko S, Mulenga L. Prevalence of subclinical cardiovascular disease in healthy HIV infected patients at the University Teaching Hospital in Lusaka, Zambia. Medical Journal of Zambia, 2016; 43 (1): 12-23.
Robbs JV, Paruk NManagement of HIV vasculopathy-a South African experience. Eur J Vasc Endovasc Surg. 2010 Mar; 39 Suppl 1: S25-S31.
Karjalainen J, Viitasalo M. Fever and cardiac rhythm. Arch Intern Med. 1986; 146 (6): 1169–1171.
Amusa GA, Akanbi MO, Okeahialam BN, Danbauchi SS, Onuh JA, Uguru SU et al. Electrocardiographic Abnormalities in HIV–infected Adults in North-Central Nigeria. Am J Respir Crit Care Med 2016; 193: A7050.
Havranek EP, Froshaug DB, Emserman CDB, Hanratty R, Krantz MJ, Masoudi FA et al. Left Ventricular Hypertrophy and Cardiovascular Mortality by Race and Ethnicity. Am J Med. 2008; 121 (10): 870-875.
Ntsekhe M, Mayosi BM. Cardiac manifestations of HIV infection: An African perspective. Nature Clinical Practice Cardiovascular Medicine. 2009; 6 (2): 120-127.
Rerkpattanapipat P, Wongpraparut N, Jacobs LE, Kotler MN. Cardiac manifestations of Acquired Immunodeficiency Syndrome. Arch Intern Med. 2000; 160 (5): 602-608.
Reinsch N, Kahlert P, Esser S, Sundermeyer A, Neuhaus K Brockmeyer N et al. Echocardiographic findings and abnormalities in HIV-infected patients: results from a large, prospective multicenter HIV-HEART study Am J Cardiovasc Dis. 2011; 1 (2): 176-184.
Olusegun-Joseph DA, Ajuluchukwu JNA, Okany CC, Mbakwem AC, DA Oke DA, Okubadejo NU et al. Echocardiographic patterns in treatment-naïve HIV-positive patients in Lagos, South-West Nigeria. Cardiovasc J Afr 2012; 23: e1-e6.
Ogunmodede JA, Kolo PM, Katibi IA, Salami AK, Omotoso A. Structural echocardiographic abnormalities seen in HIV/AIDS patients are independent of CD4 count. Niger J Clin Pract 2017; 20: 716-723.
Hsue PY, Hunt PW, Ho JR, Farah HH, Schnell A, Hoh R et al. Impact of HIV infection on diastolic function and left ventricular mass. Circ Heart Fail 2010; 3: 132-139.
Mondy K, Overton ET, Grubb J, Tong S, Sey-fried W, Powderly W et al. Metabolic syndrome in HIV-infected patients from an urban, Midwestern US outpatient population. Clin Infect Dis. 2007; 44 (5): 726-734.
Owusu KI, Oppong B. Echocardiographic abnormalities in patients with HIV Infection at Komfo Anokye Teaching Hospital, Ghana J Gen Pract 2014; 2: 2.
Herskowitz A, Vlahos D, Willoughby S, Chaisson RE, Schulman SP. Prevalence and incidence of left ventricular dysfunction in patients with Human Immunodeficiency Virus infection. American Journal of Cardiology. 1993; 71 (11): 955–958.
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