Human Immunodeficiency Virus-associated Heart Disease in Nigerian Children: A Persistent and Difficult Clinical Challenge.

Abstract

Heart disease is one of the end organ damages noticed in patients with human immunodeficiency virus (HIV)/AIDS. Its incidence globally is 20%-40%. At least 300,000 children were newly infected as of 2020 in Nigeria. This review highlights the prevalence and management challenges of childhood HIV-associated heart disease in a developing country. A search for published data on HIV-associated heart disease was done through several search engines. Keywords such as 'HIV', 'heart disease', 'HAART', 'end organ involvement in HIV', 'echocardiography' and 'children' were used. The global prevalence of HIV-associated heart disease ranged from 38.2% to 75.9%. This includes left ventricular (LV) diastolic dysfunction (30.7%-36.4%); mean mitral valve peak E/A ratio 2.09 ± 0.46, Deceleration time (DT) 230.66 ± 36.27 ms and in vitro release test 110.40 ± 10.12 ms were higher in these children than controls (P < 0.001). LV systolic dysfunction was seen in 33.7%-35.4%, dilated cardiomyopathy (6.8%-33.7%) and pericardial effusion (4.5%-14.5%). Other cardiac abnormalities were LV hypertrophy, 7.5%-10%. Management challenges include a dearth of two-dimensional echocardiographic competence in Nigeria, as services are unavailable in some tertiary centres. The comorbidity with anaemia and low systemic vascular resistance from diarrhoeal disease in these children makes diuretics difficult to use. HIV-associated heart disease is one of the common end organ involvements in children with some management challenges. There is a need for routine screening for cardiovascular abnormality at baseline and at follow-up.