Cardiac disorders in HIV-infected children in Northeastern Nigeria Hospital, Nigeria

Abstract

Human immunodeficiency virus (HIV) infection is associated with significant cardiac morbidity in children. However, comprehensive data from many parts sub-Saharan Africa, which bears the highest burden of paediatric HIV, remains limited. This study determined the prevalence, pattern, and determinants of cardiac disorders among HIV-infected children and compared findings between those on antiretroviral therapy (ART) and treatment-naïve children in northeastern Nigeria. Methodology: This hospital-based cross-sectional study enrolled 310 HIV-infected children aged 6 months to 14 years at the University of Maiduguri Teaching Hospital, Nigeria (January 2018–December 2019). Participants underwent standardised clinical evaluation, chest radiography, 12-lead electrocardiography (ECG), and transthoracic echocardiography. Cardiac disorders were defined using age-appropriate standardised criteria. Data were analysed
using SPSS version 25.0, with multivariate logistic regression to identify independent predictors of cardiac abnormalities.
P<0.05 was considered statistically significant. Results: Mean age was 107.5±40.7 months; 171 (55.2%) were male. The overall prevalence of cardiac disorders was 55.5% (172/310). Echocardiography detected abnormalities in 119 (38.4%), ECG in 90 (29.0%), and chest radiography in 24 (7.7%). Common echocardiographic findings included decreased ejection fraction (17.1%), chamber enlargement (11.3%), and dilated cardiomyopathy (6.8%). ECG abnormalities were predominantly right ventricular hypertrophy (11.6%) and sinus tachycardia (11.3%). Among 205 children on ART, 83 (40.5%) had cardiac disorders compared to 39 (37.1%) of 105 treatment-naïve children (adjusted OR=1.18, 95% CI: 0.72– 1.94, p=0.525). Advanced WHO clinical stage (aOR=3.42, 95% CI: 1.56–7.51, p=0.002) and absence of virologic suppression (aOR=2.67, 95% CI: 1.08–6.59, p=0.033) were independently associated with echocardiographic abnormalities in children on ART. Tachycardia demonstrated 78.3% sensitivity and 82.1% specificity for predicting
echocardiographic abnormalities. Conclusions: Cardiac disorders are highly prevalent among HIV-infected children in northeastern Nigeria, with subclinical abnormalities detectable by echocardiography in over one-third. Advanced immunosuppression and poor virologic control are key determinants of cardiac involvement. Routine cardiac evaluation, including echocardiography, should be integrated into paediatric HIV care programmes; tachycardia may serve as a simple clinical screening tool.