Publication:

Study to determine various echocardiographic abnormalities and its correlation with CD4 count in patients with HIV infection at tertiary care hospital in Mumbai, India

Background The prevalence of echocardiograhic abnormalities in HIV/AIDS patients is uncertain in India. Early screening and prompt treatment are important to prevent significant morbidity from cardiac involvement and to promote long term health in PLHIV. Hence the present study was undertaken to determine various Echocardiographic abnormalities and their correlation to CD4 counts.

Methods This prospective cross-sectional study was carried out in the BYL Nair Hospital, Mumbai during the period of Nov 2011 to Oct 2012. A total of 150 adult patients (age >18 years) were included. Their demographic, clinical data along with routine investigations, CD4 count, and 2D ECHO using Philips iE 33 were carried out and recorded. Echocardiographic criteria for various abnormalities were applied as per American Society of Echocardiography Guidelines. Data was analysed by using SPSS 13 software. Results reported as percentage or mean±standard deviation and p value <0.05 was considered significant.

Results In our study, 57.3% were males and 42.7% females with a mean age of 37.69(±7.81). Most patients belonged to WHO clinical Stage II (48.0%) and III (38.0%). Patients presented with symptoms of breathlessness (52.7%), fever (44.0%), chest pain (24.0%), palpitations (20.0%) and pedal edema (13.3%). CD4 count was <200/microL (40.6%), between 200-499/microL (42.3%) and ≥500/microL (17.3%). Echocardiographic abnormalities were seen in 91.3% of cases. Pulmonary artery hypertension (88.0%), diastolic dysfunction (55.3%), reduced EF (<60%) in 16.7%, LV systolic dysfunction 16%, pericardial effusions 14.3%, regional wall motion abnormalities (RWMA) seen in 12.7%, left atrial enlargement in 6% and dilated cardiomyopathy seen in 5.3% patients. Echocardiographic abnormalities increased with CD4 counts less than 200/microL was statistically significant. Pulmonary hypertension and diastolic dysfunction were seen amongst all CD4 categories.

Conclusions Echocardiographic abnormalities in PLHIV are common and increases with advanced stages of HIV infection. Pulmonary hypertension and diastolic dysfunction being most common abnormalities. Echocardiography should be included as screening for early recognition and treatment of cardiac dysfunction for promoting long term health in PLHIV.