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

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 320 AFRICA Clinical and echocardiographic findings in a cross- sectional study of HIV-infected adults in Enugu, Nigeria Paschal O Njoku, Emmanuel C Ejim, Benedict C Anisiuba, Samuel O Ike, Basden JC Onwubere Abstract Background: Human immunodeficiency virus (HIV) infection and highly active antiretroviral therapy (HAART) are impli- cated in cardiovascular diseases. The objective of this study was to evaluate the clinical and echocardiographic findings in HIV-infected adults. Methods: One hundred HIV subjects on HAART, 100 HAART-naïve patients and 100 controls were recruited in this cross-sectional study. Results: Mean CD4 cell count was significantly higher in the HAART-exposed (408.43 ± 221.62) than the HAART-naïve groups (250.06 ± 154.26) ( p < 0.001). Weight loss (49%), skin lesions (14%), body weakness (24%), oral thrush (10%) and lymphadenopathy (10%) were more prevalent in HAART- naïve patients ( p < 0.05). Dimensions of aortic root (2.71 cm), left atrium (3.27 cm) and left ventricular mass index (79.95) were significantly higher in HIV-positive subjects on HAART ( p < 0.05). Conclusion: Clinical features of HIV and the CD4 nadir were more prevalent in the HIV-positive, HAART-naïve subjects. Dimensions of the aortic root, left atrium and left ventri- cle were relatively larger in the HAART-exposed patients while wall thickness and ejection fraction were higher in the HAART-naïve subjects. Keywords: human immunodeficiency virus, antiretroviral thera- py, CD4 cell, cardiovascular, echocardiography, dimension Submitted 19/8/20, accepted 23/12/20 Published online 12/5/21 Cardiovasc J Afr 2021; 32 : 320–326 www.cvja.co.za DOI: 10.5830/CVJA-2020-065 Despite the decreasing national prevalence of human immunodeficiency virus (HIV) infection in Nigeria (1.4%) 1 and some other developing countries, the challenge of managing the burden of HIV infection still remains high due to the estimated 1.9 million 1 and 36.9 million 2 people in Nigeria and the world, respectively, living with HIV infection. These figures will likely increase with time, because of improved longevity arising from the availability of more potent antiretroviral and other antimicrobial agents used in treating affected individuals. 3,4 This challenge is compounded by cardiovascular diseases, which occur in this group of people due to the effect of both the HI virus and the antiretroviral medications employed in its treatment. The effects of HIV on the cardiovascular system are many and related to immunosuppression, with the occurrence of myocarditis, pericarditis, opportunistic infections and tumours. 5 Antiretroviral therapy used in treating HIV has been identified to cause metabolic disorders. Highly active antiretroviral therapy (HAART), especially protease inhibitors (PI), have been found to induce disorders of lipid metabolism such as diabetes and dyslipidaemia, which have been implicated in the increased incidence of cardiovascular disease in this patient population. 6,7 A few echocardiographic studies have evaluated the effect of antiretroviral therapy on cardiac function in children. 8,9 While some other similar studies in adults compared findings in HIV-positive patients as a group, with controls, 10-16 studies evaluating findings in HIV-positive HAART-naïve, HIV-positive HAART-exposed and control subjects are few and therefore underscore the need for more studies in cohorts of HIV-positive subjects taking antiretroviral therapy. This study evaluated the clinical and echocardiographic findings in two groups of HIV-infected adults and non-infected controls in Enugu, south- east Nigeria. Methods We carried out a cross-sectional study between November 2010 and November 2011 at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, and adhered to ethical standards of the Helsinki Declaration 17 (1964, amended 2008) of the World Medical Association. Approval for the study was given by the ethics committee of the UNTH, Enugu, and written consent was given by the subjects. Information obtained was made anonymous. The inclusion criteria were: adult Nigerians who were aged 18 years and above, in addition to confirmed HIV-positive serology. Enzyme-linked immunoassay (ELISA) was the method of HIV screening while confirmation was by Western blot electrophoresis. Flow cytometry was used to quantify CD4 T-lymphocytes. Fisher’s formula was used to calculate the sample size: 18 n = ​ z 2 pq ____ d 2 ​, where n = minimum sample size; z = 95% confidence level, i.e. 1.96; d = level of precision (0.075); 19 p = maximum prevalence reported in a study of a similar population 20 (13.6%); and q = 1– p . A sample size of 100HIV-positive, HAART-naïve patients was recruited consecutively. One hundred age- and gender-matched HIV-positive patients on HAART for at least three months Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria Paschal O Njoku, MB BS, MSc, FMCP, passyokuchi18@gmail.com Emmanuel C Ejim, MB BS, FMCP Benedict C Anisiuba, MB BS, FMCP Samuel O Ike, MB BS, FMCP Basden JC Onwubere, MB BS, FMCP