Cardiovascular diseases in HIV infected children and adolescents on highly anti-retroviral therapy at the university of Abuja teaching hospital, Gwagwalada, Nigeria

Authors

  • Adaora A. Okechukwu Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, FCT, Nigeria
  • Juliana O. Lawson Department of Paediatrics, Zankli Medical Center, Abuja, FCT, Nigeria
  • Onalo Richard Department of Paediatrics, University of Abuja Teaching Hospital, Gwagwalada, Abuja, FCT, Nigeria
  • Orji A. Okechukwu Paediatric Special Treatment Clinic, University of Abuja Teaching Hospital, Gwagwalada, Abuja, FCT, Nigeria

DOI:

https://doi.org/10.18203/2320-6012.ijrms20242589

Keywords:

HIV, Children, Adolescents, Troponin, Echocardiogram, Electrocardiogram

Abstract

Background: Effect of prolong use of antiretroviral therapy and chronic HIV infection on cardiac performance of infected children and adolescents requires evaluation. We studied cardiac structure/functions, and troponin levels of these subjects on anti-retroviral therapy for > 6 months in our hospital. 

Methods: A cross sectional survey was conducted in our facility for the above objectives. Bio-data, time and type antiretroviral drugs, mode of transmission, weight, height, body-mass-index, echocardiogram, electrocardiogram, CD4, viral load, and troponin were done for all subjects.

Results: Of a total of 126 subjects recruited, 66 (52.4%) were males. Their mean age, and duration on antiretroviral therapy was 14.1±3.1 (7, 18) years, and 7.2±2.9 (1, 14) years. Majority 69 (54.8%) were between 15-18 years, most 73 (57.9%) had BMI of <18 kg/m2, and 99 (78.6%) had vertical transmition. Their mean troponin-1 level was 2.0±1.6ng/ml. Abnormal echocardiogram and electrocardiogrm was detected in 41.3% and 38.1% of the subjects, with mild-systolic-dysfunction (11.9%), pulmonary-hypertension (11.1%) and left-ventricular-dysfunction (10.3%) as the commonest abnormal echocardiogram findings, and sinus-tachycardia 16 (12.7%), non-specific-ST-T abnormality 12 (9.5%), mild-right and left-ventricular-hypertrophy 4 (3.2%) as the commonest electrocardiogram abnormalities detected. Significant relationship was seen between troponin and the following variables; echocardiogram, chi2 36.95, p=0.0001; electrocardiogram, chi2 59.07, p=0.0001; body-mass-index chi2 13.63, p=0.001; 1st line antiretroviral therapy, chi2 21.187, p=0.001, 2nd line, chi2 19.978, p=0.002; CD4, chi2 6.896, p=0.032; and viral-load, chi2 7.515, p=0.023. 

Conclusions: There is high prevalence of cardiac abnormalities among the study subjects. Echocardiogram and electrocardiogram to be included in their baseline and follow-up care for early disease detection, and initiation of measures to halt its progression. 

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References

World Health Organisation. Global Health Observatory Report, 2015. Available at: http://www.who.int/gho/hiv/en/. Accessed 28 December 2015.

AVERT. HIV and AIDS in Sub-Saharan Africa, 2014. Available at: http://www.avert.org/hiv-aids-sub-saharan-africa.htm. Accessed 31 May 2015.

United Nations General Assembly Special Session Country Progress Report-2010. Available at: http://data.unaids.org/pub/report/Nigeria_2010_country_progress_report. Accessed 10 July 2013.

Lipshultz SE, Mas CM, Henkel JM, Franco VI, Fisher SD, Miller TL. HAART to heart: highly active antiretroviral therapy and the risk of cardiovascular disease in HIV-infected or exposed children and adults. Expert Revi. 2012;10:661-74.

Pongprot Y, Sittiwangkul R, Silvilairat S, Sirisanthana V. Cardiac manifestations in HIV-infected Thai children. Ann Trop Paediatr. 2004;24(2):153-9.

Hsue PY, Hunt PW, Schnell A, Kalapus SC, Hoh R, Ganz P, et al. Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis. Aids. 2009;23(9):1059-67.

Ostrowski SR, Katzenstein TL, Pedersen BK, Gerstoft J, Ullum H. Residual viraemia in HIV‐1‐infected patients with plasma viral load ≤20 copies/ml is associated with increased blood levels of soluble immune activation markers. Scandin J Immunol. 2008;68(6):652-60.

Baumeister D, Akhtar R, Ciufolini S, Pariante CM, Mondelli V. Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, inetleukin-6 and tumour necrosis factor-α. Mol Psych. 2016;21(5):642-9.

Lipshultz SE, Wong JC, Lipsitz SR, Simbre VC 2nd, Zareba KM, Galpechian V, et al. Frequency of clinically unsuspected myocardial injury at a children's hospital. Am Heart J. 2006;151(4):916-22.

Soongswang J, Durongpisitkul K, Nana A, Laohaprasittiporn D, Kangkagate C, Punlee K, et al. Cardiac troponin T: a marker in the diagnosis of acute myocarditis in children. Pediatr Cardiol. 2005;26:45-9.

Newby LK, Rodriguez I, Finkle J, Becker RC, Hicks KA, Hausner E, et al. Troponin measures during drug development-considerations for monitoring and management of potential cardiotoxicity: an educational collaboration among the Cardiac Safety Research Consortium, the Duke Clinical Research Institute, and the US Food and Drug Administration. Am Heart J. 2011;162(1):64-73.

Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92(7):2506-12.

Guaraldi G, Stentarelli C, Zona S, Santoro A, Beghetto B, Carli F, et al. The natural history of HIV-associated lipodystrophy in the changing scenario of HIV infection. HIV Med. 2014;15(10):587-94.

Dubé M, Parker RA, Pablof T, Grinspoon, SK, Zackin RA, Robbins GK, et al. Glucose metabolism, lipid, and body fat changes in antiretroviral-naive subjects randomized to nelfinavir or efavirenz plus dual nucleosides. AIDS. 2005;19(16):1807-18.

Federal Ministry of Health, National AIDS and STIs Control Programs. National Guidelines for HIV Prevention, Treatment and Care, 2020. Available at: https://naco.gov.in/sites/default/files/National_Guidelines_for_HIV_Care_and_Treatment_2021.pdf. Accessed 01 January 2024.

Olusanya O. The importance of social class in voluntary fertility control in developing country. West Afr J Med. 1985;4:205-12.

Committee Members, Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003;108(9):1146-62.

Fred S, Apple FS. Cardiac Troponin I, Cardiac Markers. Humanna Press Inc.; 1998:229-243.

Bello SO, Abdulkadir MB, Ogunkunle TO, Popoola GO, Ernest SK. Serum cardiac troponin i as a diagnostic marker of myocardial injury among human immunodeficiency virus infected children in Ilorin Kwara State Nigeria. MJPCH. 2022;28(2):98-104.

Wilkinson JD, Williams PL, Leister E, Zeldow B, Shearer WT, Colan SD, et al. Cardiac biomarkers in hiv un-infected children: the paediatric HIV/AIDS cohort study (PHACS). AIDS. 2013;27:1099-108.

Bello A, Mainasara AS, Liman HM, Hayatu U, Abubakar AF, Saidu K, et al. Troponin I as marker of subclinical cardiac injury in human immunodeficiency virus‑seropositive patients in Sokoto, Nigeria., J HIV Hum Reprod. 2016;4(1):20-6.

Undhad V V, Fefar DT, Jivani BM, Gupta H, Ghodasara DJ, Joshi BP, et al. Cardiac troponin: an emergingcardiac biomarker in animal health. Vet World. 2012;5(8):508-11.

Buiten MS, de Bie MK, Rotmans JI, Dekker FW, van Buren M, Rabelink TJ, et al. Serum cardiac troponin-I is superior to troponin-T as a marker for left ventricular dysfunction in clinically stable patients with end-stage renal disease. PLoS One 2015;10(8):1-13.

Okoromah CAN, Ojo OO, Ogunkunle OO. Cardiovascular dysfunction in HIV-infected children in a sub-saharan African country: comparative cross-sectional observational study. J Trop Pediatr. 2012;58 (1):3-11.

Shah I, Prabhu SS, Sumitra V, Shashikiran HS. Cardiac dysfunction in HIV infected children: a pilot study. Indian Pediatr. 2005;42(2):146-9.

Fink L, Reicheck N, Sutton MG. Cardiac abnormalities in acquired immunodeficiency syndrome. Am J Cardiol. 1984;54(8):1161-3.

Badal S, Gupta R, Kumar P, Sharma M, Chhajta DS. Cardiac manifestations in HIV infected children. are they under diagnosed? HIV/AIDS Res Treat Open J. 2015;2(1):21-6.

Schuster C, Mayer FJ, Wohlfahrt C, Marculescu R, Skoll M, Robert Strass R, et al. Acute HIV infection results in subclinical inflammatory cardiomyopathy. JID. 2018;218(3):466-470.

Longo-Mbenza B, Segheri LV, Vita EK. Assessment of ventricular diastolic function in AIDS patients from Congo: a Doppler echocardiographic study. Heart. 1998;80(2):184-9.

Lubega S, Zirembuzi GW, Lwabi P. Heart disease among children with HIV/AIDS attending the paediatric infectious disease clinic at Mulago hospital. Afr Health Sci. 2005;5(3):219-26.

Attamah CA, Sadoh WE, Ibadin MO, Omoigberale AI. Electrocardiographic Findings in Human Immunodeficiency Virus-Infected Children in Benin City, Nigeria. Niger Postgrad Med J. 2020;27(4):357-64.

Sani MU, Okeahialam BN, Ukoli CO. Electrocardiographic abnormalities in Nigerian AIDS patients. Trop Cardiol. 2004;30(117):3-33.

Manafe N, Ngale A, Biquiza N, Zimba I, Majid N, Mocumbi AO. Need for active cardiovascular screening in HIV-infected children under antiretroviral therapy in Africa. Cardiovasc Diagn Ther. 2019;9(1):68-72.

Idris NS, Uiterwaal CSP, Burgner DP, Grobbee DE, Kurniati N, Cheung MMH. Effects of HIV infection on pulmonary artery pressure in children. Global Hrt. 2019;14(4):367-72.

Nzuobontane D, Blackett KN, Kuaban C. Cardiac involvement in HIV infected people in Yaounde. Postgrad Med J. 2002;78(925):678-81.

Lipshultz SE, Easley KA, Orav EJ, Kaplan S, Starc TJ, Bricker JT, et al. Cardiac dysfunction and mortality in HIV-infected children: the prospective P2C2 HIV multicenter study. Circulation. 2000;102(13):1542-8.

Eleazar ES, Eleazar CI, Nwachukwu DC, Nwagha UI. ECG abnormalities among HIV infected children placed on ART at Enugu, South East of Nigeria. Afri Heal Sci. 2020;20(4):1742-8.

Li X, Ding H, Geng W, Liu J, Jiang Y, Xu J, et al. Predictive effects of body mass index on immune reconstitution among HIV-infected HAART users in China. BMC Infecti Dis. 2019;19(373).

Khair U, Mappangara I, Katu S, Bakri S, Rasyid H, Kasim H, et al. Profile of CD4 count and troponin I level in HIV Patient obtaining triple fixed dose combination (FDC) anti-retroviral therapy. Int J Med Rev Case Rep. 2019;3(5):216-20.

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Published

2024-08-31

How to Cite

Okechukwu, A. A., Lawson, J. O., Richard, O., & Okechukwu, O. A. (2024). Cardiovascular diseases in HIV infected children and adolescents on highly anti-retroviral therapy at the university of Abuja teaching hospital, Gwagwalada, Nigeria. International Journal of Research in Medical Sciences, 12(9), 3155–3163. https://doi.org/10.18203/2320-6012.ijrms20242589

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Original Research Articles