Introduction: 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.

Aims and Objectives: 1.To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection.  2. To correlate the cardiac manifestations with CD4 count.  

Materials and Method: 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 prolapse 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.

Keywords: Vitamin D levels, diabetes complications, type 2 DM, retinopathy.

1. Steinbrook, HIV in India—A Downsized Epidemic The New Eng Journ of Medicine  2008; 358: 107-9.
2. Barbarini G, Barbaro G. Incidence of the involvement of the cardiovascular system in HIV infection. AIDS 2003; 17 : 46-50.
3. Barbaro G, Di Lorenzo G, Grisorio B et al. Cardiac involvement in the acquired immunodeficiency syndrome: a multicenter clinical-pathological study. AIDS Res Hum Retroviruses 1998;14:1071-7.
4. Patel K, Van Dyke RB, Mittleman MA et al. International Maternal Pediatric Adolescent AIDS Clinical Trials 219219C Study Team. The impact of HAART on cardiomyopathy among children and adolescents perinatally infected with HIV-1. AIDS 2012; 16:2027-37.
5. Stewart JM, Kaul A, Gromisch DS et al. Symptomatic cardiac dysfunction in children with human immunodeficiency virus infection. Am Heart J 1989;117 (1):140-4.
6. Fisher SD, Easley KA, Orav EJ et al. Pediatric Pulmonary and Cardio-vascular Complications of Vertically Transmitted HIV Infection Study Group. Mild dilated cardiomyopathy and increased left ventricular mass predict mortality: the prospective P2C2 HIV Multicenter Study. Am Heart J 2005 ;150(3):439-47.
7. Longo-Mbenza B, Seghers KV, Phuati M et al. Heart involvement and HIV infection in African patients: determinants of survival. Int J Cardiol 1998 ;64(1):63-73.
8. Friis-Moller N, Sabin CA, Weber R et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003;349:1993–2003.
9. Arminio A, Sabin CA, Phillips AN et al. Cardio and cerebrovascular events in HIV-infected persons. AIDS 2004;18:1811–7.
10. Gottdiener JS, Bednarz J, Devereux R et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Echocardiography in Clinical Trials. J Am Soc Echocardiogr 2004; 17: 1086–1119.
11. Feigenbaum H. Echocardiography. Philadelphia: Lippincott William and Wilkins, 2005: 138–80.
12. Henry WL, De Maria A, Gramiak R, et al. Report of the American Society of Echocardiography committee on nomenclature and standards in 2-D echocardiography.Circulation 1980; 62: 212–7.      
13. Cardoso JS, Miranda AM, Moura B et al. Cardiac morbidity in the human immunodeficiency virus infection. Rev Port Cardiol 1994;13:901-11.
14. Herskowitz A, Vlahov D, Willoughby S et al. Prevalence and incidence of left ventricular dysfunction in patients with human immunodeficiency virus infection. Am J Cardiol 1993 ;71:955-8.
15. Jain N, Reddy DH, Verma SP et al. Cardiac Abnormalities in HIV-Positive Patients: Results from an Observational Study in India. J Int Assoc Physicians AIDS Care 2012 ;11:113-8
16. Wu TC, Pizzorno MC, Hayward GS et al. In situ detection of human cytomegalo-virus immediate-early gene transcripts within cardiac myocytes of patients with HIV-associated cardiomyopathy. AIDS 1992 ;6:777-85.
17. Mirri A, Rapezzi C, Iacopi F et al.Cardiac involvement in HIV infection: a prospective, multicenter clinical and echocardiographic study. Cardiologia 1990 ;35:203-9.
18. Nzuobontane D, Blackett KN , Kuaban C. Cardiac Involvement in HIV infected people in Yaounde Cameroon. Postgrad Med J 2002; 78:678–81.
19. Longo-Mbenza B, Seghers KV, Phuati M et al .Heart involvement and HIV infection in African patients: determinants of survival. Int J Cardiol. 1998; 64(1): 63–73.
20. Corallo S, Mutinelli MR, Momoi M. et al. Echocardiography detects myocardial damage in AIDS:prospective study in 102 patients. Eur Heart J 1988; 9: 887–92.
21. Ntsekhe M, Hakim J. Impact of human immunodeficiency virus infection on cardiovascular disease in Africa. Circulation 2005; 112: 3602–7.
22. Barbaro G, Lorenzo G, Grisorio B et al. Incidence of dilated cardiomyopathy and detection of HIV in myocardial cells of HIV positive patients. N Engl J Med 1998; 339: 1093–9.
23. Barbaro G, Di Lorenzo G, Soldini M et al. The intensity of myocardial expression of inducible nitric oxide synthase influences the clinical course of human immunod-eficiency virus-associated cardiomy-opathy. Circulation 1999;100: 633–9.
24. Lipshultz Dilated cardiomyopathy in HIV-infected patients.N Engl J Med 1998; 339: 1153–5.
25. Moreno, J. P. Villacastin, H. Bueno et al.Clinical and Echocardiographic Findings in HIV Patients with Pericardial Effusion, Cardiology 1997;88: 397-400.
26. G. Hakim, J. A. Matenga and S. Siziya, Myocardial Dysfunction in HIV Infection: An Echocardiographic Study of 157 Patients in Hospital in Zimbabwe. Heart 1996;76: 161-5.
27. Aggarwal, A. Sharma, R. Bhardwaj et al.Myocardial Dysfunction in Human Immunodeficiency virus Infection: An Echocardiographic Study.Journal of the Association of Physicians of India 2009;57: 745-6.
28. B. Himelman, W. S. Chung, D. N. Chernoff et al. Cardiac Manifestations of Human Immunodeficiency Virus Infection: A Two-Dimensional Echocardiographic Study.Journal of the American College of Cardiology 1989;13:1030-6.

Piyush Saxena

Associate Professor, Department of Medicine, Motilal Nehru Medical College, Prayagraj