Ghanaian Study Identifies Potential Benefit of Cardiac Function Evaluation in HIV

Incorporating echocardiograms (ECGs) and electrographic assessments of cardiac function into routine multidisciplinary care for persons living with HIV (PLWH) should be considered, in light of the common occurrence of cardiac abnormalities among this patient population, report recent study results in International Journal of General Medicine.

Previous results have been mixed on the utility of ECGs and electrographic assessments of cardiac function among PLWH, particularly findings on a potential connection between cardiac abnormalities and highly active antiretroviral treatment (HAART), the authors noted.

The current investigators carried out their prospective cross-sectional study among patients receiving HIV-related care at the HIV clinic of Komfo Anokye Teaching Hospital in Kumasi, Ghana. There were 2 patient cohorts: 157 PLWH on HAART and 28 PLWH not on HAART. Their mean (SD) age was 50.5 (9.8) years, 74.1% were female, and 67.0% had completed basic education.

Findings show that more patients in the HAART-naïve group were younger (aged 18-30 or 31-40 years) compared with the HAART group: 57.2% vs 49.7%. Echocardiographic parameters did not differ significantly between the groups; however, median (IQR) heart rate, PR interval, and QRS complex duration were higher in the HAART group compared with the HAART-naïve group:

• Heart rate: 87 (77-96.5) vs 82.5 (68.75-95.75) bpm
• PR interval: 168 (144-183) vs 157 (140.5-173.5) ms
• QRS complex duration: 88 (82-98) vs 87 (82-95) ms

Additional data show that within the HAART group, those with an efavirenz-based regimen had a higher heart rate but a lower median PR interval and QRS complex duration compared with those taking a nevirapen-based regimen:

• Heart rate: 88 (77-97) vs 82.5 (68.75-95.75) bpm
• PR interval: 168 (141.5-182.0) vs 170 (148-192) ms
• QRS complex duration: 86 (81.5-98.0) vs 90 (82-100) ms

A higher prevalence of cardiac abnormalities was seen overall in the treatment-naïve group vs those on HAART: 60.7% vs 54.1%. Pulmonary hypertension was the most common echocardiograph abnormality, followed by pericardial effusion and left ventricular systolic dysfunction (22.7%, 22.2%, and 17.8%, respectively).

More than half of all study participants (53.5%) and of the HAART cohort (54.1%) had a normal ECG, with their most common abnormalities being nonspecific T-wave changes and sinus tachycardia (36.1% and 30.6%, respectively). However, most abnormalities were shown to be more common in the group whose HAART regimen had a nevirapine backbone vs an efavirenz backbone.

Nonspecific T-wave changes were the most common abnormality overall and in both study groups (36%, 35.7% in the HAART-naïve group, 36.1% in the HAART group), followed by sinus tachycardia (31.4%, 35.7%, 30.6%, respectively) and “others” (11.6%, 14.3%, 11.1%). These trends mostly held true when considering the specific ART regimen (efavirenz or nevirapen), except that first-degree AV block was the third most common ECG abnormality in the those taking nevirapen vs “others” among participants taking efavirenz (11.8% and 13.2%).

Despite slight differences in the above findings, the authors deemed those variations nonsignificant.

“Our current study, which confirms no significant difference in the findings between PLWHIV on HAART and the treatment naïve, implies that cardiac abnormalities are not significantly due to HAART,” the authors concluded. “Our current study further confirms no significant difference in the rate of echocardiographic and ECG abnormalities between different regimens of HAART.”

Suggesting that the high rates of echocardiographic and ECG abnormalities they saw were more likely related to actually having HIV, the authors recommend incorporating these tests as routine evaluations among PLWH, to improve not only their disease management but also their quality of life.

Reference

Owusu IK, Wiafe YA, Opoku S, Anto EO, Acheamfour-Akowuah E. Cardiac abnormalities of people living with HIV: a comparative study between HAART experience and treatment naïve groups in Ghana. Int J Gen Med. 2022;15:5849-5859. doi:10.2147/IJGM.S366688