Title: Impact of CD4+ lymphocyte count on left ventricular systolic function in newly diagnosed HAART naïve HIV/AIDS patients seen at University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State
Authors: A.C. Mankwe ND, MBBCH, MSc, FWACP, O. J. Odia MBBS, FMCP, FWACP, FRCP, Edin
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.01
Abstract
Background: HIV-related cardiomyopathy is a notable complication of HIV infection attributed to various aetiologic factors including myocardial infection with HIV itself, opportunistic infections, nutritional deficiencies and cardiotoxicity from therapeutic or illicit drugs. These factors become more manifest as CD4+ count decreases in the clinical course of HIV infection.
Method: This was a cross-sectional case-control study. One hundred newly diagnosed HAART naïve HIV/AIDS subjects and one hundred age and sex matched HIV negative controls were recruited and evaluated clinically. CD4+count of the cases were estimated. Left ventricular function was assessed using transthoracic echocardiography.
Results: Systolic dysfunction assessed using ejection fraction was more common in the cases than in the control group (26% versus 5%). There was statistically significant difference in the systolic function of the two groups (p=0.001) and a significant positive correlation between the ejection fraction and CD4+ count (r=0.310, p=0.002). Subjects with CD4+ count <200 cells/µL were more likely to have systolic dysfunction (OR=3.33, P=0.01).
Conclusion: Left ventricular systolic dysfunction was shown in this study to be more common in people with HIV/AIDS than in the control group and there was a significant positive correlation between CD4+ lymphocyte count and left ventricular systolic function.
Recommendation: The heart may be a marker of the HIV infected patient’s overall health, and a decline in cardiac function may suggest low CD4+ count and should trigger more comprehensive evaluation and possibly early intervention of the patient.
Keywords: Systolic function, CD4+ count, HIV, ejection fraction, echocardiograghy.
References
1. Umeora OU, Ejikeme BN, Obuna JA. Knowledge and Attitude of Pregnant Women in Rural Nigeria to Voluntary Counseling and Testing (VCT) for Human Immunodeficiency Virus Infection/ Acquired Immunodeficiency Syndrome (HIV/AIDS). Nigerian Medical Journal 2007; 48(2) 27 -30.
2. Levy WS, Simon GL, Rios JC et al. Prevalence of Cardiac Abnormalities in Human Immunodeficiency Virus Infection. A. M. J. Cardiol 1989; 63: 86 -9.
3. Anthony SF, Cliffort HL. Human Immunodeficiency virus disease; AIDS and related disorders. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, LoscalzoJ. Harrison’s Principles of Internal medicine. Seventeenth Edition. McGraw-Hill 2008; 1137-1204.
4. Friis – Moller N, Weber R, Reiss P, et al. Cardiovascular Risk Factors in HIV Patients – Association With Antiretroviral Therapy. Results from the DAD study. AIDS 2003 17: 1179 -1193.
5. Cole JW, Pinto AN, Hebal JR, et al. Acquired Immunodeficiency Syndrome and the Risk of Stroke 2004; 35(1): 51-56.
6. Barbaro G, Di Lorenzo, Grisorio B, et al. Incidence of dilated Cardiomyopathy and Detection of HIV positive patients. N. Engl J. Med 1998; 339: 1093 - 9.
7. Levy D, Garrison GJ, Savage DD et al. Prognostic Implications of Echocardiographically determined left ventricular mass in the Framingham heart study. 1990; 322: 1561- 1566.
8. Verdechia P, Porcellati C, Reboldi G, et al. left ventricular hypertrophy as an independent predictor of acute cerebrov-ascular events in essential hypertension. Circulation 2001; 104: 2039-2044.
9. Haider AW, Larson MG, Benjamin EJ, et al. Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death J. AM CollCardiol. 1998; 32: 1454 – 1459.
10. Corallo S, Mutinelli MR, Moroni M, et al. Echocardiography detects myocardial damage in AIDS: prospective study in 102 patients Eur Heart J. 1988; 9: 887 -92.
11. Himelman RB, Chung WS, Chernoff DN, et al. Cardiac Manifestation of Human Immunodeficiency Virus Infection: a two Dimensional Echocardiographic Study. J.AM COLL Cardiol 1989; 13: 1030 – 6.
12. Herskowitz A, Vlahov D, Willoughby S, et al. Prevalence and incidence of left ventricular dysfunction in patients with human immunodeficiency virus infection A. M. J. Cardiol 1993; 71: 955 -8.
13. CoudrayN, De Zuttere D, Force G, et al. left ventricular diastolic dysfunction in asymptomatic and symptomatic human immunodeficiency virus carriers: an echocardiographic study Eur Heart J.1995; 16: 61-7.
14. Danbauchi S, Sani B, Alhassan A. Echocardiographic features of HIV/AIDS subjects on 1-2 years of ARV drugs in Nigeria. Available at hhtp://www.2umdnj.edu/schinler/hivecho.html. Accessed on 6/11/11.
15. Okeahialam BN, Anjorin FL. Echocardiographic study of the heart in AIDS. The Jos Experience. Trop Card 2000; 26: 3-6.
16. USPHS/IDSA prevention of opportunistic infections working group. USPHS/IDSA guidelines for the prevention of opport-unistic infections in persons infected with human immunodeficiency virus. MMWR Recom, Rep 1997; 46(RR – 12): 1 – 46.
17. Masar H, Ognibene FP, Yarchoan R, et al. CD4 Counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med. 1989; W: 223 – 31.
18. Phair J. Munoz A, Detels R, et al. The risk of pneumocystis Carinii pneumonia among men infected with human immunodefi-ciency virus type 1. N Engl J. med 1990; 322: 161 -5.
19. Centers for Disease Control 1993 Revised Classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992; 41: 1-19.
20. Currie PF, Jacob AJ, Foreman AR et al: Heart Muscle disease related to HIV infection: prognostic implications. B. M. J. 1994; 309: 1605-7.
21. Herskowitz A, Willoughby SB Vlahov D, et al. Dilated heart muscle disease associated with HIV infection Eur Heart J. 1995; 16 (Suppl): 50 -5.
22. Barbaro G, Di Lorenso G: predictive value of ventricular ectopic beats in diagnosis of HIV-related myocarditis: a retrospective analysis of Holter electrocardiographic recordings, echocardiographic parameters and histological findings (abstract) chest 1995, 108: 1015.
23. Blanchard DG, Hagenhoff C, Chow LC, et al. Reversibility of Cardiac Abnormalities in Human Immunodeficiency Virus (HIV)-infected individuals: a serial echocardi-ographic study. J AMCollCardiol 1991; 17: 1270 -6.
24. World Health Organization. Obesity and overweight [internet]. Available online from www.WHO/obesity/overweight com. Cited Jan 2011
25. Du Bois D, Du Bois E. A formula to estimate the approximate surface area if height and weight be known. Arch Intern med. 1916; 17:863-867
26. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16:31-34
27. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Disease 2002; 39 (suppl 1 ): 1-266
28. Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of Low Density Lipoprotein in Plasma without Use of Preparative Ultracentrifugation. Clin. Chem 1972; 18: 499-502
29. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002; 106: 3143
30. Sahn DJ, De Maria A. Kissi J, et al. The Committee on M – Mode Standardization of the American Society of Echocard-iography. Recommendations regarding quantification in M-Mode echocardio-graphy: results of a survey of echocardiog-raphic measurements, circulation 1978; 58: 1072 – 1083.
31. Teicholz LE, Kreulen T, Herman MV, et al. Problems in Echocardiographic- angiographic correlations in the presence or absence of asynergy. A M J cardiol. 1976; 37:7-11.
32. United Nations AIDS UNAIDS report on the global AIDS epidemic 2010; 364p. http://www.unaids.org/en/ (25 October 2011)
33. WHO. WOMEN and HIV/AIDS [interact]. Available online from www.who.int/inf-fs/en/fact 242. html cited Jan 2014.
34. Sani MU, Okeahialam BN, Ukoli CO. Electrocardiographic abnormalities in Nigerian AIDS patients. Trop Card 2004; 30: 3–6
35. Glulio PT, patrizion BA. HIV envelope glycoprotein (gp120) interacts with astro-glial beta adrenergic receptors. Int. confi. AIDS Florence. 1991 abstract MA 1037.
36. Stein JH: Managing cardiovascular risk in patients with HIV infection. J Acquir Immune DeficSyndr 2005; 38:115.
37. Fisher SD, Bowles NE, Towbin JA, Lipshultz SE: Mediators in HIV- associated cardiovascular disease: A focus on cytokines and genes. AIDS 2003; 17:S29.