Publication:

Cardiac manifestations in HIV patients and their correlation with CD4 count

Background The introduction of highly active antiretroviral therapy (HAART) has significantly improved the clinical evolution of human immunodeficiency virus (HIV)/AIDS disease, with an increased survival of infected patients. With advances in the management of patients living with HIV and AIDS, not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Objectives were to determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection, and to correlate the cardiac manifestations with CD4 count.

Methods 115 HIV-positive cases and 30 healthy control subjects were evaluated by detailed history and general physical examination. CD4 was done for all patients using flowcytometry using a BD FACS Count system. All patients were evaluated using M Mode and two-dimensional transthoracic echocardiography and colour flow doppler examination.

Results Male to female ratio was1.6:1in cases. The most common symptoms were cough (54.78%), palpitations (10%), shortness of breath (52%), chest pain on exertion (18.0%) and ankle swelling (21.0%). Echocardiographic abnormalities were found in 63% of the cases compared with 6% in the controls. 18 (15.65%) patients had dilated cardiomyopathy, 17 (15%) pericardial effusion, 16 (14%) pulmonary artery hypertension, 17 (15%) mitral valve prolapses and 25 (22%) had reduced ejection fraction compared with none of controls. 54 (47%) cases had diastolic dysfunction compared with 3 (10%) controls and 40 (35%) cases had reduced fractional shortening (≤27%) compared 4 (13%) controls. Significant statistical positive correlation was not observed between low CD4 count and echocardiographic abnormalities. Pericardial effusion was seen more in patients with CD4 count below 200.

Conclusions Cardiovascular abnormalities in HIV infected patients are common and can occur without any clinical manifestation. There was no significant association between CD4 count and any cardiac manifestation.