The 12-month period prevalence and cardiac manifestations of HIV in patients with acute coronary syndrome at a tertiary hospital in Cape Town, South Africa: a retrospective cross-sectional study

Camilla Pennefather,Eric H. Decloedt,Anton Doubell,Tonya Esterhuizen

doi:10.1186/s12879-021-06367-2

Camilla Pennefather, Eric H. Decloedt + Show 2 more

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https://doi.org/10.1186/s12879-021-06367-2

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Abstract

BackgroundHIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults.MethodsWe included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups.ResultsAmong 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3–4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd’s ratio (OR) (95% CI): 3.12 (1.2–8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2–8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS.ConclusionsWe found an HIV-prevalence of 3.4% (95% CI 2.3–4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.

Highlights

HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD)
We found an HIV-prevalence of 3.4% in adults with acute coronary syndrome (ACS) in a high endemic HIV region
HIV-positive patients were younger and more likely to present with segment elevation myocardial infarction (STEMI) and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS

Summary

Introduction

HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Antiretroviral therapy (ART) treated HIV-positive patients are experiencing fewer HIV-related opportunistic infections and are increasingly being affected by the same ageassociated spectrum of atherosclerotic disease, including coronary artery disease (CAD), as the general population [2]. CAD accounts for 8–22% of deaths among the HIV-positive population, making it an important cause of morbidity and mortality [4] This is in contrast to the pre-ART era, when cardiomyopathies, pancarditis, conduction system abnormalities, pulmonary hypertension leading to heart failure, and neoplastic infiltration were more important cardiac manifestations of HIV infection [5]. Despite much data from Europe and North America, there are limited studies from South Africa, a low and middle-income country (LMIC), reporting on the prevalence of HIV in ACS, as well as the CAD risk factors, cardiac manifestations and management of ACS in these patients [6]. Non-ST-elevated myocardial infarction (NSTEMI) and unstable angina (UA) are the most common presentations of ACS in HIV-uninfected persons [1]

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