Echocardiographic Findings in HIV Positive Children on Anti-retroviral Therapy Attending Routine Outpatient Infectious Disease Clinics in the Niger Delta Region of Nigeria

Main Article Content

Chika O. Duru
Nsirimobu I. Paul
Immaculata Tunde-Oremodu

Abstract

Background: The aim of this study was to investigate the echocardiographic findings of stable HIV positive children on Highly Active Anti-retroviral Therapy (HAART) attending routine Paediatric Infectious disease clinics in the Niger Delta region of Nigeria.

Methods: Over a 3 month period (1st October to 31st December 2019) 71 apparently stable HIV positive children who had been on HAART for at least 3 months had a transthoracic echocardiogram done after written informed consent. A proforma containing their clinical and socioeconomic information and the echocardiographic findings was filled. Data was entered into an Excel spread sheet and analysed using SPSS 22.0.

Results: Among the 71 children studied, 34 (47.89%) were aged 6 – 10 years, 42 (59.15%) were females while 15 (26.01%) belonged to social class 3. Of the 71 participants studied, forty-four (61.97%) had abnormal echocardiographic findings on echocardiogram. Mild pulmonary regurgitation was the commonest finding and occurred in 32 (45.07%) of the patients. This was followed by Left Ventricular diastolic dysfunction (LVDD) which occurred in 9 (12.68%) patients, while Left Ventricular systolic dysfunction (LVSD) and Congenital heart defects occurred in 6 (8.45%) subjects each. There was no significant association between occurrence of echocardiographic findings and age, gender, duration of HIV disease, type of HAART and stage of disease at diagnosis and at the time of the study (p<0.05).

Conclusion: This study shows that mild pulmonary regurgitation is the commonest echocardiographic finding among stable HIV patients followed by left ventricular dysfunction. Routine baseline and intermittent echocardiography are recommended for initial evaluation and continued care for early detection and quick intervention of cardiac diseases of children with HIV disease. 

Keywords:
Echocardiographic findings, Human Immunodeficiency Virus (HIV), Niger Delta.

Article Details

How to Cite
Duru, C. O., Paul, N. I., & Tunde-Oremodu, I. (2020). Echocardiographic Findings in HIV Positive Children on Anti-retroviral Therapy Attending Routine Outpatient Infectious Disease Clinics in the Niger Delta Region of Nigeria. Advances in Research, 21(1), 22-33. https://doi.org/10.9734/air/2020/v21i130179
Section
Original Research Article

References

Joint United nations programme on HIV/AIDS and World Health Organization (WHO) Report on the Global HIV/AIDS Epidermic. Geneva. World Health Organization; 1997.

Paediatric care and treatment- UNICEF DATA.
Available:https://data.unicef.org>topic>hivaids>paediatric-treatment-and-care

Lepage P, Spira R, Kalibala S, et al. Care of HIV infected children in developing countries. Pediatr Infec Dis J. 1998;17: 581–58.

Lipshultz SE, Easley KA, Orav EJ, et al. Cardiac dysfunction and mortality in HIV-infected children: The prospective P2C2 HIV Multicenter Study Circulation. 2000; 102:1542–8.

Lipshultz S, Chanock S, Sanders SP, et al. Cardiac manifestations of human immunodeficiency virus infection in infants and children. Am J Cardiol. 1989;63:1489–97.

Ige OO, Oguche S, Bode-Thomas F. Left ventricular systolic function in nigerian children with human Immunodeficiency virus infection. Congenit Heart Dis. 2012; 7:417–42.

Ige OO, Oguche S, Yilgwan CS, Bode-Thomas F. Left ventricular mass and diastolic dysfunction in children infected with the human immunodeficiency virus. Nig J Cardiol. 2014;11:8-12.

Arodiwe I, Ikefuna A, Obidike E, Ibeziako N et al. Left ventricular systolic function in Nigerian children infected with HIV/AIDS: A cross-sectional study Cardiovasc J Afr. 2016;27(1):25-29

Okoroma CAN, Ojo OO, Ogunkunle OO. Cardiovasculat dysfunction in HIV- infected children in sub-saharan Africa: A cross-sectional observational study. J Trop Paediatr; 2011.

Animashaun BA, Diaku-Akinwumi IN, Ubuane PO, Ibitoye E. Cardiac size and systolic function of HIV infected Lagos children accessing routine care: A pilot study. J Xiangya Med. 2018;3:14.

Lubega S, Zirembuzi GW, Lwabi P. Heart disease among children with HIV/AIDS attending the paediatric infectious disease clinic at Mulago Hospital. African Health Sciences. 2005;5(3):219-226.

Majonga ED, Rehman AM, Simms V, Mchugh G, Mujuru HA, Nathoo K et al. High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy. AIDS. 2018; 32:2739–2748.

van Rossum AM, Fraaij PL, de Groot R. Efficacy of highly active antiretroviral therapy in HIV-1 infected children. Lancet Infect Dis. 2002;2(2):93–102.
DOI: 10.1016/S1473-3099(02)00183-4 7

Gortmaker SL, Hughes M, Cervia J, Brady M, Johnson GM, Seage GR III, et al. Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. N Engl J Med. 2001;345(21):1522–8.
DOI: 10.1056/NEJMoa011157

Fettig J, Swaminathan M, Murrill CS, Kaplan JE. Global epidemiology of HIV. Infect Dis Clin North Am. 2014;28:323–37.

Lumsden RH, Bloomfield GS. The causes of HIV-associated cardiomyopathy: A Tale of Two Worlds. BioMed Research International. 2016;9.
[Article ID 8196560]
DOI:http://dx.doi.org/10.1155/2016/8196560

Cheitlin MD, Armstrong WF, Aurigemma GP, et al. American College of Cardiology; American Heart Association; and American Society of Echocardiography. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography, Circulation. 2003;108: 1146-62.

World Health Organization. Interim WHO Clinical Staging System for HIV/AIDS and HIV/AIDS case definitions for surveillance: African region. Switzerland: World Health Organization; 2005.

Lai WW, Geva T, Shirali GS, Frommelt PC, Humes RA, Brook MM et al. Guidelines and standards for performance of a pediatric echocardiogram: A Report for the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19:1413-1430.

Oyedeji GA. Socioeconomic and cultural background of Hospitalized children in Ileha. Nig J Paed. 1985;12(4):111-117.

Shah I, Prabhu SS, Sumitra V, et al. Cardiac dysfunction in HIV infected children: A pilot study, Ind Paediatr. 2005; 42:146-9.

Sherron P, Pickoff AS, Ferrer PL, et al. Echocardiographic evaluation of myocardial function in paediatric AIDS patients [abstract] Am Heart J. 1985;110: 710.

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

Chelo D, Wawo E, Siaha V, Anakeu A, Ateba F, Ndongo FA et al. Cardiac anomalies in a group of HIV-infected children in a Pediatric hospital: An echocardiographic study in Yaounde, Cameroon. Cardiovasc Diagn Ther. 2015; 5(6):444-453.

Brand A, Dollberg S, Keren A. The prevalence of valvular regurgitation in children with structurally normal hearts: A color Doppler echocardiographic study. Am Heart J. 1992;123(1):177-180.

Ayabakan C, Özkutlu S, Kiliç A. The Doppler echocardiographic assessment of valvular regurgitation in normal children. The Turk J Pediatr. 2003;45:102-107.

Majonga ED, Rehman AM, Mchugh G, Mujuru HA, Nathoo K, Odland JO, Ferrand RA, Kaski JP. Incidence and Progression of Echocardiographic Abnormalities in Older Children with Human Immunodeficiency Virus and Adolescents Taking Antiretroviral Therapy: A prospective cohort study. Clinical Infectious Diseases; 2019.
DOI: 10.1093/cid/ciz373

Hsue PY, Farah HH, Bolger AF, Palav S, Ahmed S, Schnell A. et al Diastolic Dysfunction is Common in Asymptomatic HIV Patients. Conference Reports for NATAP. 15th CROI, Boston; 2008.

Lipshultz SE, Williams PL, Wilkinson JD, Leister EC, Van Dyke RB, Shearer WT. et al. Cardiac Status of HIV-Infected Children Treated With Long-Term Combination Antiretroviral Therapy: Results from the Adolescent Master Protocol of the NIH Multicenter Pediatric HIV/ AIDS Cohort Study. JAMA Pediatr. 2013;167(6):520–527. DOI:10.1001/jamapediatrics.2013.1206

Sibiude J, Le Chenadec J, Bonnet D, Tubiana R, Faye A, Dollfus C, et al. In Utero Exposure to Zidovudine and Heart Anomalies in the ANRS French Perinatal Cohort and the Nested PRIMEVA Randomized Trial. Clinical Infectious Diseases. 2015;61(2): 270–0.

Lai WW, Lipshultz SE , Easley KA, Starc TJ, Drant SE, Bricker JT, et al. Prevalence of Congenital Cardiovascular Malformations in Children of Human Immunodeficiency Virus-Infected Women: The Prospective P2C2 HIV Multicenter Study. J Am Coll Cardiol. 1998;15;32(6): 1749–1755.

Patel K, Van Dyke RB, Mittleman MA, Colan SD, Oleske JM, Seage GR. 3rd International Maternal Pediatric Adolescent AIDS Clinical Trials 219219C Study Team. The impact of HAART on cardiomyopathy among children and adolescents perinatally infected with HIV-1. AIDS. 2012;26:2027–37,27.

Obel N, Farkas DK, Kronborg G, et al. Abacavir and risk of myocardial infarction in HIV-infected patients on highly active antiretroviral therapy: a population based nationwide cohort study. HIV Med. 2010; 11:130–6.