PREVALENCE OF ELECTROCARDIOGRAPHIC CHANGES IN APPARENTLY HEALTHY CHILDREN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS IN BENIN CITYNIGERIA

Abstract

Human immunodeficiency virus (HIV) infection is a pandemic with Sub-Saharan Africa most
affected. Cardiovascular diseases can arise from HIV disease and also from its treatment with
highly active antiretroviral therapy (HAART) in children.
Cardiovascular diseases in HIV infected subjects are usually subclinical and often go
unrecognized. These often clinically inapparent HIV associated cardiovascular diseases that
are detectable by ECG changes have not been adequately described in children in Sub
Saharan Africa where the HIV burden is high.
This cross-sectional and descriptive study was carried out to determine the prevalence of
ECG changes, the spectrum of electrocardiographic changes, the relationship between
electrocardiographic changes and HAART and between clinical status and
electrocardiographic changes in HIV infected children in Benin-City-Nigeria
Two hundred HIV infected apparently healthy children aged 18 months to 17 years were
recruited from paediatric HIV clinic in UBTH and Central Hospital whether or not they were
on HAART. The same number of age and sex matched controls were recruited from
apparently healthy children attending follow up care in the General Practice Clinics of the
respective hospitals. All the subjects and controls had a standard 12-lead surface ECG
recording. Blood samples were collected for determination of CD4 count of subjects and HIV
status of controls.
Sixty two percent were males and 38% were females with a male: female ratio of 1.6:1 and
the mean age of the study subjects and control group were 8.30 ± 3.92 and 8.41 ± 3.99 years
respectively. The modal age was 8 years and constituted 10% of the study population.The prevalence of ECG changes in HIV infected children was 34.5% and was significantly
higher than the 4.5% among controls (p= <0.0001). The spectrum of electrocardiographic
changes in this study ranged from sinus tachycardia found in 18.5% of subjects, prolonged
PR interval, significantly higher in subjects (5.0%) than controls (0.5%) with (p= 0.011),
prolonged QRS interval in (3.5%) of the subjects, prolonged QTc interval in 3.5% of the
subjects. Other electrocardiographic changes identified in this study include ST segment
depression, significantly more prevalent in subjects (6.5%) than controls (0.5%). (p=
<0.0001), left atrial hypertrophy also significantly more prevalent in subjects (7.0%) than
control (0.5%) (p= <0.001). Right ventricular hypertrophy, left ventricular hypertrophy and
multiple ECG changes were also reported in this study and their prevalences were higher in
the subjects compared to the control and the differences were all statistically significant.
(p=0.019, p=0.002, p= <0.0001 respectively)
One hundred and sixty six subjects (83.0%) were HAART experienced compared to 34
(17.0%) who were HAART naive. The prevalences of ECG changes were higher in HAART
experienced subjects compared to HAART naive subject. Also the mean duration of ECG
parameters were higher among HAART experienced compared to HAART naive subjects.
However the differences were not statistically significant.
Electrocardiographic changes increased in prevalence as the clinical status and staging
progressively worsened.
In conclusion cardiovascular disease presents as a significant health challenge among HIV
infected children especially those on HAART and worsening clinical status. It is
recommended that all HIV infected children be screened for cardiovascular disease using the
electrocardiogram to detect early cardiovascular changes so as to enhance early and
appropriate intervention.

PREVALENCE OF ELECTROCARDIOGRAPHIC CHANGES IN APPARENTLY HEALTHY CHILDREN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS IN BENIN CITYNIGERIA