Cardiac Manifestations In Children With Acquired Immunodeficiency Syndrome At Kenyatta National Hospital
Abstract
Introduction: AIDS and its associated opportunistic infections and neoplasms affect
virtually every organ. The heart of the patient with AIDS is also affected in a number of
mechanisms that result in its dysfunction. No study has been done locally to show the
prevalence of cardiac disease in children with AIDS.
Objective: To determine the cardiac profiles of children with AIDS at the Kenyatta
National Hospital.
Design: Cross-sectional study.
Setting: The Kenyatta National Hospital general paediatric wards.
Subjects: Sick children aged below 12years, who met the WHO clinical diagnostic criteria
for paediatric AIDS and had a positive HIV ELISA test.
Procedures: The subjects had a full haemogram, a plain chest x-ray, surface
electrocardiography and echocardiography done.
Study duration: December 2002 - May 2003. ..
Results: A total of99 subjects were recruited to the study. Fifty five (56%) were males and
44 (44%) were females. The age range was 3months to 144months, with a median age of
36months and mean age of 4years /month. Cardiac involvement was revealed in 64 (65%)
subjects. Of these, left ventricular dysfunction was found in 35 (35%) subjects, pericarditis
and or pericardial effusion in 27 (27%) subjects, myocarditis in 21 (21%) subjects, and
pulmonary hypertension in 15 (15%) subjects. Left ventricular dysfunction was
significantly correlated with anaemia, p-value 0.014, odds ratio 4.06 and 95% confidence
interval 1.16 - 15.56. Dyspnoea was significantly related to right ventricular dysfunction,
p-value 0.009, odds ratio 10; 95% confidence interval 1.27 - 213.1. From the logistic
regression model, pneumonia was of statistical significance as a correlate to cardiac
disease. It seemed to confer protection, p-value of 0.014 odds ratio 0.155 and a 95%
confidence interval of 0.035 - 0.681.
Conclusion: The study revealed a high prevalence of cardiac disease in children with AIDS
(65%), the commonest problem being left ventricular dysfunction on (35%). Right
ventricular dysfunction was significantly related to dyspnoea. Left ventricular dysfunction
was significantly related to anaemia.
Recommendation: Cardiac evaluation by echocardiography should be done on all patients
with AIDS since clinical characteristics are not reliable predictors for cardiac
complications.
Citation
Masters in The University Of Nairobi, 2004Publisher
University of Nairobi Centre for HIV prevention & Research