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Semulimi AW, Kyazze AP, Kyalo E, Mukisa J, Batte C, Bongomin F, Ssinabulya I, Kirenga BJ, Okello E. Review of electrocardiographic abnormalities among people living with HIV in Sub-Saharan Africa: A systematic review. PLoS One 2023; 18:e0283419. [PMID: 36952493 PMCID: PMC10035850 DOI: 10.1371/journal.pone.0283419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/09/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Electrocardiographic (ECG) abnormalities are increasingly being reported among people living with HIV (PLWH). However, the exact prevalence of ECG abnormalities among PLWH in Sub-Saharan Africa (SSA), a region with one of the highest burdens of HIV, is not known. Through a systematic review, we determined the prevalence and patterns of ECG abnormalities among PLWH in SSA. METHODS We conducted a search in online databases including EMBASE, MEDLINE, CINAHL and Research for Life for studies published between 1st January 2000 and 31st December 2020. Studies reporting any form of ECG abnormalities published in English were screened and reviewed for eligibility. Retrieved studies were assessed for validity using the modified Newcastle-Ottawa Scale. Data was summarized qualitatively, and ECG abnormalities were further subcategorized into rate, conduction, and rhythm abnormalities as well as atrial and ventricular enlargements. RESULTS We retrieved seventeen of the 219 studies assessed for eligibility published between 2001 and 2020, with a total of 2,572 eligible participants. The mean age of the participants ranged between 6.8 years and 58.6 years. Of the 17 studies, 8 (47%) were case-control, 6 (35.3%) cross-sectional and 3 (17.6%) were cohort in design. Thirteen studies were conducted in the adult population while four were conducted in the pediatric population. The prevalence of ECG abnormalities ranged from 10% to 81% and 6.7% to 26.5% in the adult and pediatric population respectively. Among studies done in the adult population, conduction abnormalities were the most reported (9 studies) with a prevalence ranging from 3.4% to 53.5%. In the pediatric population, rate abnormalities were the most reported (4 studies) with a prevalence ranging from 3.9% to 20.9%. The heterogeneity in results could be attributed to the absence of uniform criteria to define ECG abnormalities. CONCLUSION Our findings highlight a high prevalence of ECG abnormalities among PLWH in SSA. Consideration of ECG in the comprehensive evaluation of cardiac dysfunction among PLWH in SSA maybe warranted.
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Affiliation(s)
- Andrew Weil Semulimi
- Department of Medicine, Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Peter Kyazze
- Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edward Kyalo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Batte
- Department of Medicine, Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Faculty of Medicine, Department of Medical Microbiology & Immunology, Gulu University, Gulu, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Bruce J Kirenga
- Department of Medicine, Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmy Okello
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
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Bloomfield GS, Weir IR, Ribaudo HJ, Fitch KV, Fichtenbaum CJ, Moran LE, Bedimo R, de Filippi C, Morse CG, Piccini J, Zanni MV, LU MT, Hoffmann U, Grinspoon SK, Douglas PS. Prevalence and Correlates of Electrocardiographic Abnormalities in Adults With HIV: Insights From the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE). J Acquir Immune Defic Syndr 2022; 89:349-359. [PMID: 35147583 PMCID: PMC8837824 DOI: 10.1097/qai.0000000000002877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk of cardiovasvular disease (CVD) and sudden cardiac death. Previous work has suggested an association between HIV infection and electrocardiographic (ECG) abnormalities. There are limited data on the burden of ECG abnormalities among PWH in a multiracial, multiethnic globally representative population. SETTING One hundred twenty sites in the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE). METHODS ECG findings were grouped into clinically relevant categories using sex-specific thresholds when indicated. We used the Fisher exact tests to assess associations of demographic characteristics and ECG abnormalities. We used logistic regression model to assess associations between demographic and HIV management measures, with adjustment. RESULTS We analyzed data for 7720 PWH (99% of participants) (median age 50 years, 69% male participants). There were 3346 (43%) Black or African American, 2680 (35%) White, and 1139 (15%) Asian participants. Most of the participants (97%) had viral load that was <400 copies/mL or 400 copies/mL had approximately twice the odds of prolonged QTc compared with those that were undetectable (adjusted OR: 2.05, 95% CI: 1.22 to 3.45). CONCLUSIONS Prolonged QTc is common among male, Asian, and REPRIEVE participants with higher viral loads. These relationships warrant future investigation of linkages to ensuing CVD events among PWH.
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Affiliation(s)
| | - Isabelle R. Weir
- Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research in the Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston MA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Laura E. Moran
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | | | | | | | - Jonathan Piccini
- Duke Clinical Research Institute, Duke University School of Medicine, Durham NC
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael T. LU
- Massachusetts General Hospital Cardiovascular Imaging Research Center and Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- Massachusetts General Hospital Cardiovascular Imaging Research Center and Harvard Medical School, Boston, MA
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham NC
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Williams C, Kamau FM, Everson F, Kgokane B, De Boever P, Goswami N, Webster I, Strijdom H. HIV and Antiretroviral Therapy Are Independently Associated with Cardiometabolic Variables and Cardiac Electrical Activity in Adults from the Western Cape Region of South Africa. J Clin Med 2021; 10:4112. [PMID: 34575223 PMCID: PMC8466610 DOI: 10.3390/jcm10184112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular-related complications are on the rise in people with HIV/AIDS (PWH); however, the relationship among HIV and antiretroviral therapy (ART)-related parameters, cardiovascular risk, and cardiac electrical activity in PWH remain poorly studied, especially in sub-Saharan African populations. We investigated whether HIV and ART are associated with cardiometabolic and cardiac electrical activity in PWH from Worcester in the Western Cape Province, South Africa. This was a cross-sectional study with HIV-negative (HIV-, n = 24) and HIV-positive on ART (HIV+/ART+, n = 63) participants. We obtained demographic, lifestyle, and medical history data and performed anthropometric, clinical assessments, and blood/urine biochemistry. We performed multiple stepwise linear regression analyses to determine independent associations among HIV, ART, cardiometabolic, and electrocardiographic (ECG) variables. HIV+/ART+ independently associated with a lower body mass index (p = 0.004), elevated gamma-glutamyl transferase levels (β: 0.333 (0.130-0.573); p = 0.002), and elevated alanine aminotransferase levels (β: 0.427 (0.224-0.629); p < 0.001) compared to HIV-. Use of second-line ART was positively associated with high-sensitivity C-reactive protein (p = 0.002). Although ECG parameters did not differ between HIV- and HIV+/ART+, viral load positively associated with p-wave duration (0.306 (0.018-0.594); p = 0.038), and longer HIV duration (≥5 years) with ST-interval (0.270 (0.003-0.537); p = 0.047) after adjusting for confounding factors. Our findings suggest that HIV and ART are associated with mixed effects on this population's cardiometabolic profile and cardiac electrical activity, underpinning the importance of cardiovascular risk monitoring in PWH.
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Affiliation(s)
- Cassidy Williams
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Festus M. Kamau
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Frans Everson
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Boipelo Kgokane
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Patrick De Boever
- Department of Biology, University of Antwerp, 2610 Wilrijk, Belgium;
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, 8036 Graz, Austria;
| | - Ingrid Webster
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
| | - Hans Strijdom
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (C.W.); (F.E.); (B.K.); (I.W.); (H.S.)
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Clauss M, Chelvanambi S, Cook C, ElMergawy R, Dhillon N. Viral Bad News Sent by EVAIL. Viruses 2021; 13:v13061168. [PMID: 34207152 PMCID: PMC8234235 DOI: 10.3390/v13061168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023] Open
Abstract
This article reviews the current knowledge on how viruses may utilize Extracellular Vesicle Assisted Inflammatory Load (EVAIL) to exert pathologic activities. Viruses are classically considered to exert their pathologic actions through acute or chronic infection followed by the host response. This host response causes the release of cytokines leading to vascular endothelial cell dysfunction and cardiovascular complications. However, viruses may employ an alternative pathway to soluble cytokine-induced pathologies-by initiating the release of extracellular vesicles (EVs), including exosomes. The best-understood example of this alternative pathway is human immunodeficiency virus (HIV)-elicited EVs and their propensity to harm vascular endothelial cells. Specifically, an HIV-encoded accessory protein called the "negative factor" (Nef) was demonstrated in EVs from the body fluids of HIV patients on successful combined antiretroviral therapy (ART); it was also demonstrated to be sufficient in inducing endothelial and cardiovascular dysfunction. This review will highlight HIV-Nef as an example of how HIV can produce EVs loaded with proinflammatory cargo to disseminate cardiovascular pathologies. It will further discuss whether EV production can explain SARS-CoV-2-mediated pulmonary and cardiovascular pathologies.
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Affiliation(s)
- Matthias Clauss
- IU School of Medicine, Pulmonary, Critical Care, Sleep and Occupational Medicine, Indianapolis, IN 46202, USA;
- Correspondence: or
| | - Sarvesh Chelvanambi
- Brigham and Women’s Hospital, Department of Medicine, Boston, MA 02115, USA;
| | - Christine Cook
- Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.C.); (N.D.)
| | - Rabab ElMergawy
- IU School of Medicine, Pulmonary, Critical Care, Sleep and Occupational Medicine, Indianapolis, IN 46202, USA;
| | - Navneet Dhillon
- Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.C.); (N.D.)
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