HIV-associated cardiovascular diseases: Is there a link between HIV and CVD?

By Jodie Jacobs

A question on the rise is whether HIV has a direct correlation on cardiovascular disease.  The emerging prevalence of cardiovascular diseases (CVD) present in HIV-infected patients is particularly interesting. People infected with HIV who die from cardiovascular complications is rising in comparison to people who die as a result of the virus itself. So, what does this mean?  Testing individuals who are HIV-positive for heart diseases and defects will help improve treatment and management regimes for those suffering from both diseases. In turn, this will lower the death rate caused by the world’s leading cause of death, cardiovascular disease. In this particular study, researchers investigated the prevalence and range of heart diseases in children in the Pediatric Infectious Disease clinic at Mulago Hospital in Sub-Saharan Africa where more than 50% of the world’s HIV-infected individuals reside.

Using imaging techniques, 230 children (112 males and 118 females) were examined where 13.9% had asymptomatic HIV, 67.8% had AIDS related complex and 18.3% had AIDS. Any structural defects relating to congenital heart disease, dimensions of heart chambers during relaxation and expansion, function of left ventricle, valve function and direction of blood flow were examined.

Of the 230 patients, 81.7% of patients were symptomatic for HIV while 18.3% were asymptomatic. The range of heart defects detected included Left ventricular systolic dysfunction (failure of heart to pump sufficient blood), right ventricular dilatation (chamber enlargement), pericardial effusion (excess fluid in pericardial cavity), congenital heart disease, dilated cardiomyopathy (ineffective pumping of blood), right and left  ventricular hypertrophy (thickening of heart wall), partial right bundle branch block and sinus tachycardia (elevated heart rhythm) with sinus tachycardia (25.53%) and left ventricular systolic dysfunction (21.28%) being the most significant. Only 5 children presented with cardiac abnormalities prior to the investigation. Other abnormalities included atrial septal defect (hole in the heart wall between two chambers) and mitral valve disease (partially functioning mitral valve).

Now the question would be what is the link between the two? Well, this study looked at the development and signs of heart defects in HIV-positive children who had no previous signs or complications. Cardiovascular abnormalities such as sinus tachycardia and left ventricular systolic dysfunction were found to be most prevalent in children with AIDS compare to those with ARC and who were asymptomatic. The direct effect which HIV has on cardiac abnormality development is yet to be established but a famous theory includes the role HIV plays in immune activation and inflammation that contributes to CVD risk and abnormalities. Countries in Sub-Saharan Africa where HIV is highly prevalent appears to increase the prevalence of cardiac abnormalities which may increase mortality rate. So, it is recommended that children suffering from HIV and ARC should be screened for any cardiovascular abnormalities as it will assist in effective treatment procedures and disease management.

Reference

Lubega S, Zirembuzi GW, Lwabi P. 2005. Heart disease among children with HIV/AIDS attending the paediatric infectious disease clinic at Mulago Hospital. African health sciences5(3): 219-226.

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