EVALUATION OF THE CARDIOVASCULAR FEATURES OF HIV INFECTED CHILDREN SEEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH)

Abstract

Cardiac dysfunction is a known complication of HIV infection, attributed to direct
invasion of the heart by the virus or due to side effects of antiretroviral drugs and it may
contribute to morbidity and mortality. This study was aimed at determining the
prevalence, pattern and associations of cardiac dysfunction in children with HIV/AIDS in
Lagos University Teaching Hospital (LUTH) using a combination of methods.

The cross-sectional study was conducted in 83 HIV-infected children and 83 age and sex
matched apparently healthy controls, aged 18 months to 12 years, seen at the Lagos
University Teaching Hospital (LUTH). Consecutive HIV infected subjects who were
receiving care at LUTH and met the inclusion criteria were recruited into the study. The
selected aspects of their cardiovascular function were evaluated through clinical
examination, electrocardiography (ECG) and echocardiography.

The overall prevalence of cardiovascular abnormalities among the study group was
75.9%, with the greater proportion (87.3%) occurring in patients with AIDS rather than
the pre-AIDS group (12.7%). The spectrum of abnormalities included tachypnoea,
tachycardia and heart failure on clinical examination; sinus tachycardia, sinus
arrhythmias, prolongation of the PR and corrected QT (QTc) intervals and prolonged P
wave on ECG; depressed fractional shortening (FS), increased left ventricular mass
(LVM) and pericardial effusion on echocardiography.
The mean ages at diagnosis in the pre-AIDS and AIDS groups were 34.5 ± 25.9 months
and 59.5 ± 36.4 months respectively, (t=3.05, p=0.0054). The mean heart rate (103  18
beats/minute) and respiratory rate (29  7 cycles/minute) were significantly faster in the
AIDS group compared to the control
(97  12 beats/minute and 26  5 cycles/minute respectively), p=0.003 and 0.002
respectively. Features suggestive of heart failure were found in 10 (12%) subjects with
HIV/AIDS.
Thirty (36.1%) HIV/AIDS subjects had abnormal ECG recordings, which ranged from
sinus tachycardia and sinus arrhythmias to prolongation of PR and QTc intervals (0.13 
0.02 second and 0.41  0.03 second respectively) and prolonged P wave duration (0.08 
0.01 second).

Echocardiographic abnormalities which consisted of depressed fractional shortening
(found in 30 subjects) and an increased LVM were noted in the AIDS group. The mean
values were 22.61  4.75 and 79.81  30.04 respectively, compared to 39.79  6.32 and
71.55  22.96 respectively in controls. Ten (12%) HIV/AIDS subjects also had mild
posterior pericardial effusion with measurements ranging from 0.27-0.51 cm, using the
tip of the mitral valve as the reference point.

Advanced stage of disease was not significantly associated with the development of
cardiovascular abnormalities. Fifty-five (87.3%) subjects with cardiovascular
abnormalities had category C symptoms as against 2 (3.2%) and 6 (9.5%) subjects with
categories A and B symptoms of the CDC revised classification system respectively. This
was however, not statistically significant when compared to the other children with
HIV/AIDS with no cardiovascular abnormalities (p=0.09).
Cardiovascular abnormalities were seen more frequently amongst HIV/AIDS patients
who were receiving antiretroviral treatment than amongst those who were not (t=6.91,
p=0.009).

Using a combination of clinical examination, ECG and echocardiography, cardiovascular
abnormalities in HIV infection are more likely to be detected. As such, baseline and
periodic cardiac examinations should be incorporated in the management plan for
children with HIV infection.

EVALUATION OF THE CARDIOVASCULAR FEATURES OF HIV INFECTED CHILDREN SEEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH)