Study of cardiac manifestations in people living with HIV using echocardiography and association with CD-4 counts and other factors

Authors

  • Rajat Jain Department of Medicine, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
  • Deepak Bhasney Department of Medicine, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
  • Ashutosh Garg Department of Medicine, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India https://orcid.org/0009-0002-5259-9783

DOI:

https://doi.org/10.18203/2349-3933.ijam20251938

Keywords:

AIDS, Cardiovascular diseases , CD4-count, Echocardiography, HIV, People living with HIV

Abstract

Background: As the AIDS related deaths have declined, due to introduction of ART, the survival of people living with HIV (PLWH) has increased, leading to increased prevalence of chronic conditions like cardiovascular diseases. India has the second highest burden of HIV-AIDS globally so there is a need for studying cardiovascular diseases in this population. Present study was undertaken to study the cardiac manifestations in people living with HIV using echocardiography and other tools and their correlation with CD4-counts and other factors.

Methods: A cross-sectional study was done on 200 patients divided into two equal groups based on HIV-ELISA status. Known cases of coronary heart disease, structural and valvular heart disease were excluded. Participants underwent basic investigations, chest X ray, ECG, TMT, NTProBNP and echocardiography. PLWH also had their CD4-counts measured. A statistical analysis was performed and the prevalence of cardiovascular abnormalities and presence of related associations was sought.

Results: 26% of PLWH showed abnormal echocardiography with prevalence odd’s ratio of 3.16 when compared to non-HIV group.  Diastolic dysfunction was the most common abnormality found. Older age (>50 years), presence of comorbidities, low CD4 counts, advanced WHO staging, non-intake of ART and presence of opportunistic infections were positively and significantly associated with echocardiographic abnormalities in PLWH.

Conclusions: There is high prevalence of cardiovascular diseases among PLWH. Echocardiography may be used as screening tool. Newer ART regimens and High CD4-counts seem to be cardioprotective. There is need for further prospective studies on larger scale to accurately determine associated risk factors.

Metrics

Metrics Loading ...

References

Schalkwyk C, Mahy M, Johnson LF, Imai-Eaton JW. Updated data and methods for the 2023 UNAIDS HIV estimates. J Acq Imm Def Syndr. 2024;1;95(1):1-4. DOI: https://doi.org/10.1097/QAI.0000000000003344

National AIDS Control Organisation & ICMR-National Institute of Medical Statistics. India HIV Estimates 2020: Technical Brief. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. 2021.

Kaul S, Fishbein MC, Siegel RJ. Cardiac manifestations of acquired immune deficiency syndrome: a 1991 update. American Heart J. 1991;122(2):535-44. DOI: https://doi.org/10.1016/0002-8703(91)91013-D

Fauci S, Folkers GK. “Human Immunodeficiency Virus Disease: AIDS and Related Disorders,” In: A. S. Fauci, et al., Eds., Harrison’s Principles of Internal Medicine, 21sh Edition, McGraw Hill Company Inc. 2018.

Deeks SG. HIV infection, inflammation, immunosenescence and aging. Annual review of medicine. 2011;62(1):141-55. DOI: https://doi.org/10.1146/annurev-med-042909-093756

Freiberg MS, McGinnis KA, Kraemer K, Samet JH, Conigliaro J, Ellison RC, Bryant K, Kuller LH, Justice AC, VACS Project Team. The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men. J Acquired Immune Def Synd. 2010;53(2):247-53. DOI: https://doi.org/10.1097/QAI.0b013e3181c6c4b7

Vaillant AA, Naik R. HIV-1–Associated Opportunistic Infections. InStatPearls. StatPearls Publishing. 2023.

Lundgren JD. Combination antiretroviral therapy and the risk of myocardial infarction. The data collection on adverse events of anti-HIV drugs (DAD) Study Group. New England J Med. 2003;349(21):1993-2003. DOI: https://doi.org/10.1056/NEJMoa030218

Shah AS, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation. 2018;138(11):1100-12. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.033369

Helleberg M, Kronborg G, Larsen CS, Pedersen G, Pedersen C, Obel N, Gerstoft J. CD4 decline is associated with increased risk of cardiovascular disease, cancer and death in virally suppressed patients with HIV. Clinical Infect Dis. 2013;57(2):314-21. DOI: https://doi.org/10.1093/cid/cit232

Knudsen AD, Kofoed KF, Gelpi M, Sigvardsen PE, Mocroft A, Kühl JT, et al. Prevalence and risk factors of prolonged QT interval and electrocardiographic abnormalities in persons living with HIV. Aids. 2019;33(14):2205-10. DOI: https://doi.org/10.1097/QAD.0000000000002327

Reinsch N, Neuhaus K, Esser S, Potthoff A, Hower M, Brockmeyer NH, et al. German Competence Network Heart Failure and the German Competence Network for HIV AIDS. Prevalence of cardiac diastolic dysfunction in HIV-infected patients: results of the HIV-HEART study. HIV Clin. 2010;11(3):156-62. DOI: https://doi.org/10.1310/hct1103-156

Cerrato E. Cardiac Dysfunction in Pauci Symptomatic Human Immunodeficiency Virus Patients: a Meta-analysis in the Highly Active Antiretroviral Therapy Era. Eur Heart J. 2013;34(19):1432-6. DOI: https://doi.org/10.1093/eurheartj/ehs471

Woldeyes E, Fisseha H, Mulatu HA, Ephrem A, Benti H, Alem MW, et al. Echocardiographic findings and associated factors in HIV-infected patients at a tertiary hospital in Ethiopia. Medicine. 2022;101(33):30081. DOI: https://doi.org/10.1097/MD.0000000000030081

Aggarwal P, Sharma A, Bhardwaj R, Raina R. Myocardial dysfunction in human immunodeficiency virus infection: an echocardiographic study. J Assoc Physicians India. 2009;57:745-6.

Reddy CT, Shastry AB, Madhyastha SP, Shetty GV, Acharya V, Doddamani A. A Study of Cardiovascular Manifestations in HIV Positive Patients and Their Association with the CD4 Cell Count. J Evol Med Dental Sci. 2021;10(1):7-13. DOI: https://doi.org/10.14260/jemds/2021/2

Chaudhary S, Apurva SK, Reddy DH, Yadav SC, Patel ML, Tripathi AK, Vaish AK. A study of cardiovascular abnormalities in HIV positive patients in a tertiary care hospital in Northern India. J Assoc Physicians India. 2017;65(12):24-9.

Islam FM, Wu J, Jansson J, Wilson DP. Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis. BMC Pub Health. 2012;12:1-5. DOI: https://doi.org/10.1186/1471-2458-12-234

Downloads

Published

2025-06-26

How to Cite

Jain, R., Bhasney, D., & Garg, A. (2025). Study of cardiac manifestations in people living with HIV using echocardiography and association with CD-4 counts and other factors. International Journal of Advances in Medicine, 12(4), 395–401. https://doi.org/10.18203/2349-3933.ijam20251938

Issue

Section

Original Research Articles