Evaluation of Cardiac Dysfunctions in Patients with HIV

Moulick N D, Naik K V, Padhiyar R N, Chavan S

Moulick N D, Naik K V, Padhiyar R N, Chavan S

Keywords: HIV, Cardiac Dysfunctions, Pericardial Effusion

Abstract

Objectives: HIV compromises the immunity of a person to such a level that the person affected becomes highly vulnerable to variety of infectious and non-infectious diseases. For many years the infectious diseases were focused upon as they carried the major proportion of HIV/AIDS related mortality. Infection with HIV is one of the causes of acquired heart disease. Thus cardiac involvement in HIV affected patients is becoming more prevalent as therapy and longevity improve. With this view in mind we undertook the study of cardiac manifestations in patients with HIV.
Methods: This was an observational study, conducted in a tertiary care centre with an aim to study cardiac parameters in patients who have HIV.
Results: 151 HIV positive cases were studied over a period of 18 months. Majority of our patients were middle aged with average age of 38.7 years. 59.7% were males and 40.3% were females. Out of the 151 cases included 52(34.4%) had CD4 count < 200, 58(38.4%) had CD4 between 200-350 and 41(27.2%) had CD4 count > 350. 116(76.8%) patients had normal LVEF (> 60%) and 35(23.2%) had low LVEF (<60%). 11.9% patients had pericardial effusion. 26.4% patients had diastolic dysfunction and 15.9% of our patients had Pulmonary Arterial Hypertension.
Conclusion: Cardiac complications of HIV infection tend to occur late in the disease or are associated with related therapies. Cardiac involvement is common among HIV patients with 35.7% of our patients having cardiac involvement. 25.7% patients had some abnormal 2D echo findings which was associated with low CD4 count (< 350).

References

1. AIDS epidemic update: November 2009, “UNAIDS/09.36E / JC1700E” Journal by Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization-2009.
2. Harrison’s Principles of Internal Medicine 18th edition, Chapter 189, Human Immunodeficiency Virus Disease: AIDS and Related Disorders.
3. Annual HIV Sentinel Surveillance Country Report 2006, UNAIDS INDIA, 2008.
4. http://www.unaids.org/en/regionscountries/countries/ india Epidemiological Fact Sheet on HIV and AIDS, 2009, INDIA, UNAIDS.
5. Al-Attar I, Orav EJ, Exil V et al. Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome. J Am CollCardiol. 2003; 41:1598.
6. Lipshultz SE, Fisher SD, Lai WW, Miller TL. Cardiovascular risk factors, monitoring, and therapy for HIV-infected patients. AIDS 2003; 17:S96.
7. Currie PF, Boon NA. Immunopathogenesis of HIVrelated heart muscle disease: Current perspectives. AIDS. 2003; 17:S21.
8. Barbaro G. HIV-associated cardiomyopathy etiopathogenesis and clinical aspects. Herz. 2005;30(6):486-92
9. Chengat V, Subbiah R, Raghunath O, Rathinavel A.Profile of HIV Associated Cardiomyopathy and Cardiac Isoform of Alpha Two Macroglobulin. The Internet Journal of Cardiology. 2010;8(1).
10. Aggarwal P, Sharma A, Bhardwaj R, Raina R. Myocardial dysfunction in human immunodeficiency virus infection: an echocardiographic study. JAPI. 2009;57:745-6.