Electrocardiographic Abnormalities Among HIV Infected Adults Attending The Comprehensive Care Center At Kenyatta National Hospital

Abstract

Background: Cardiovascular disease is a growing concern among the HIV infected population. HIV positive individuals have a greater risk of both traditional cardiovascular risk factors and cardiovascular events than non-HIV individuals. Various ECG abnormalities have been shown to be predictor for adverse cardiovascular outcomes. Resting ECG testing can be a convenient tool for cardiovascular screening and risk stratification. There is no data in Kenya on the prevalence and types of ECG abnormalities amongst HIV infected adults. Objectives: The primary objective was to describe the prevalence and types of ECG abnormalities among HIV positive adults attending the Comprehensive Care Center at Kenyatta National Hospital. The secondary objective was to determine the association between the presence of ECG abnormalities and demographic characteristics, selected cardiovascular risk factors (hypertension, diabetes mellitus, smoking, obesity) and HIV related factors (the nadir CD4 cell count and antiretroviral therapy status) of the patients. Methodology: This was a cross sectional study conducted at the Comprehensive Care Center at KNH. Patients meeting the inclusion criteria and giving written consent were enrolled in the study. A resting 12 lead ECG was recorded for each patient by standard procedure. The ECGs were interpreted as per the AHA/ACC recommendations for the standardization and interpretation of the electrocardiogram. Results: 200 participants were included. Mean age was 44 years, 69.5% were female. Mean duration of HIV infection was 101 months (SD 68.3). 99% were on HAART and 12.7% on second line HAART. Mean nadir CD4 cell count was 283.7 (SD 239.8). Mean BMI was 26.3 (SD 5.6). Hypertension and type 2 diabetes were present in 20% and 2.5% respectively. An abnormal ECG was found in 68 (34%) participants. Arrhythmias were seen in 37 participants, T wave abnormalities in 15 participants, LVH and QTc prolongation were both present in 7 participants. Conduction abnormalities were seen in 9 participants. ST segment abnormalities and pathological Q waves were observed in 3 and 2 participants respectively. There was no association between any demographic and HIV factors with any ECG abnormality. Conclusion: One in 3 HIV participants had at least one ECG abnormality. Minor abnormalities had the highest prevalence. Clinical significance of these ECG abnormalities among our HIV population still needs to be established.