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.