A comparitive study of cardiovascular manifestations in treatment naive versus “on-treatment” patients with retroviral disease

Abstract

Background:ART increases the longevity of the patients infected with HIV so mortality due to Opportunistic infections is reducing and late complications like cardiovascular manifestations are on its rise. Cardiac involvement can be over looked in HIV positive patients because symptoms of breathlessness, fatigue and poor exercise tolerance are ascribed to other conditions associated with HIV patients. Objectives: Primary:To evaluate cardiac manifestations and determine type of cardiac involvementin both ART naïve patients and patients on ART and correlate with CD4+ counts.Methods:200 HIV infected patients presenting in OPD and inpatients are included. Information is collected and detailed history is taken using pre-formed proforma. At the time of admission or follow up, steps are taken to send for all the investigations and detailed clinical examination of the patient done, focusing more on cardiovascular system. Results: 41% of the patients with normal cardiac function were NOT ON ART and 62.7% of the patients with cardiac dysfunction were HIV naïve and it was found to be statistically significant(p value 0.003).Tricuspid regurgitation(42.1% vs 57.9%, p value 0.035) and IHD(0% vs 100% p value 0.049) found to have significant association in patients who were ON ART. Systolic dysfunction (p value 0.048) and IHD(p value 0.019) were both significantly associated with the low CD4+ counts in patients NOT ON ART. Conclusion :There was significant association of ART on the occurrence of cardiac dysfunction. Cardiac dysfunction is noted with low CD4+Counts, it is therefore important to undergo 2DECHO at diagnosis and at regular intervals in all HIV infected patients and to initiate early treatment for the same.