CARDIOVASCULAR MANIFESTATIONS IN HIV POSITIVE PATIENTS IN A TERTIARY CARE HOSPITAL, CENTRAL INDIA

Abstract

Background: Acquired immune deficiency syndrome (AIDS) is one of the major public health problem in india .HIV estimates report (2019)(1) of the Government, India is estimated to have around 23.49 lakh people living with HIV/AIDS (PLHIV) in 2019 . in Chhattisgarh it is 42520&HIV incidence per 1,000 uninfected population is 0.1 .with the recent advancements in therapy early mortality in HIV cases are significantly reduced but cardiovascular abnormalities are frequently seen as the disease progress and is associated with decreased quality of life.
 Aims and objective: To know the pattern and prevalence of various cardiovascular manifestations in HIV positive patients and its association with CD4 count, WHO stage of disease and ART
 Material and Methods: for the period of 1.3 years from JANUARY 2019 TO APRIL 2020studyis conducted in the Department of Medicine, PT.JNM Medical College and Dr. BRAMH, Raipur. A total of 137 HIV positive patients of age>18 years, all are on ART are included.patients included in the study underwent detailed history taking, clinical examination and investigations. Details of the history, clinical examination and investigations were noted in the proforma. The cardiovascular examination in the form of chest x-ray, ECG, 2D echocardiography and NT-ProBNP was done and their correlationswith CD4 count and WHO disease stage is studied accordingly. Electrocardiogram, chest x-ray and 2D echocardiography was done immediately following blood investigation.
 Result: Majority (45.25%) of the patients involved in this study were in age group of 31-45 year with the overall average mean age of 38.86 years. Male to female ratio was 3.1:1. On x-ray cardiomegaly found in 25.5% pts baseline ECG abnormalitities seen in 47.4% pts . echocardiographic abnormality seen in 56.2% pts .The commonest finding in our study is valvular abnormalities in 55 pts (40.1%) followed by diastolic dysfunction in 45 pts(32.8%). Other less common cardiac manifestations in decreasing order of frequency were reduced LVEF in 33 pts(24%), pericardial effusion in 15 pts (10.9%),left ventricular hypertrophy in 13 pts (9.4%), pulmonary arterial hypertension in 10 pts (7.2%)and regional wall motion abnormality in 9 pts (6.5%). We found A strong statistical correlation found between CD4 count and pericardial effusion in 2D-ECHO (p= 0.0410023). Also strong statistical correlation (p=0.016456) is found between the WHO stage of disease and cardiomegaly, strong statistical correlation found between WHO staging of disease and QRS abnormalities (p= 0.02551) and inverted T wave (p= 0.000528), strong statistical correlation found between WHO stage of disease and pulmonary arterial hypertension in 2D-ECHO (p=0.006832). And statistical association found between WHO stage of disease and regional wall motion abnormality (RWMA) in 2D-ECHO (p=0.002541).
 Conclusion: The results of the study indicate that cardiovascular abnormalities in HIV infected patients are common. Cardiac involvement and cardiovascular complications are commonly seen in HIV-infected patients and can present without any clinical manifestation. The common cardiovascular manifestation seen in our study patients is valvular leaks, regional wall motion abnormality, pericardial effusion, reduced EF etc. The incidence of cardiovascular manifestations increases as the disease progresses and CD4 count decreases.
 Keywords: Prevalence, Cardiovascular, Abnormalities & HIV.
 Study Designed: Cross Sectional Observational Study.