Cardiovascular Involvement in People Living with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy

Abstract

Background: With the advent of HAART, natural history of HIV/AIDS has changed radically and PLHIV who are treated before significant immunosuppression can expect to have a longer life expectancy. Previous studies have suggested a rising rate of non-AIDS related events in HIV infected individuals of which cardiovascular diseases constitute significant morbidity and mortality. Identification of factors augmenting the cardiovascular risk is important in the management of HIV. Methods: The present study was a cross-sectional, observational study carried out in a tertiary care centre from January 2021 to July 2022. 200 HIV positive individuals on HAART for atleast 2 years were included who underwent ECG, chest radiograph, 2D Echocardiography and CD4+ T cell count along with other routine investigations. Presence of cardiovascular involvement was determined on the basis of echocardiographic abnormalities and these findings were associated with demographic, haematological and biochemical profile of the patients. The echocardiographic abnormalities were correlated with CD4+ T cell count and clinical stage of the disease. Results: 38.50% of the population had abnormal ECG findings of which sinus tachycardia was the most common (30.00%). The prevalence of echocardiographic abnormalities was 41.00%. The most common echocardiographic abnormality was diastolic dysfunction (32.00%) followed by valvular insufficiency (21.00%) and reduced LVEF (15.00%). The mean of CD4+ T cell count in those with abnormal echocardiographic findings was 194.43 ± 161.4 cells/mm3 which was significantly lower than those with normal echocardiographic findings (555.02 ± 393.36 cells/ mm3). With decrease in the CD4+ T cell count and with increase in WHO stage, cardiac abnormalities increased significantly. Higher grades of diastolic dysfunction were seen with CD4+ T cell count < 350/mm3 and WHO stages 3 and 4. Conclusion: In the present study, there was a high prevalence of cardiovascular abnormalities among PLHIV. Lower CD4+ T cell count was an independent risk factor for cardiovascular abnormalities and hence predicts the occurrence of cardiovascular disorders among PLHIV.