Echocardiographic abnormalities and disease severity (based on CD4 count) in treatment-naive HIV positive patients

Purpose: Human immunodeficiency virus (HIV) infection may be associated with cardiac abnormalities. These abnormalities appear to be more frequent with disease progression. This study sought to examine the relationship between HIV disease severity in treatment-naive patients and cardiac abnormalities identified by echocardiography.

Material and methods: 100 HIV-positive, treatment-naive patients, comprising 53 patients with CD4 count < 200/µl (AIDS group) and 47 patients with CD4 count ≥ 200/µl (non-AIDS group) without any traditional risk factors for cardiac disease were recruited for the study. Both groups had clinical and echocardiographic evaluation for cardiac abnormalities.

Results: Of the 53 patients in the AIDS group, 11.5% had dilated cardiomyopathy (DCM), compared with none in the non-AIDS group (p = 0.018). Systolic dysfunction was higher in the AIDS group when compared with the non-AIDS group (42.3% and 17.0%, respectively; p = 0.006). Also, those in the AIDS had a significantly higher left ventricular end diastolic diameter index when compared with the non-AIDS group (2.87 ± 0.37 and 2.67 ± 0.29, respectively; p = 0.004). Furthermore, moderate to severe pericardial effusion was more frequent in the AIDS group, when compared with non-AIDS group (15.38% and 2.12%, respectively; p = 0.045). Diastolic dysfunction was also more frequent in AIDS group, although this did not achieve statistical significance (34.64% and 29.78%, respectively; p = 0.61).

Conclusion: Cardiac abnormalities are more frequent with disease progression in HIV infected patients. Patients with more advanced disease (CD4 < 200/µl) had significantly more frequent systolic dysfunction, DCM, larger left ventricular dimension, and moderate to severe pericardial effusion than those with CD4 ≥ 200/µl.