Electrocardiographic abnormalities to the patients infected with HIV/AIDS under antiretroviral tritherapy at the University Clinics of Kinshasa

Abstract

Abstract Introduction: Electrocardiogram (ECG) abnormalities are common to HIV-infected patients on antiretroviral therapy (ART). However, the relationship between ART, cardiovascular risk and cardiac electrical activity to patients living with HIV (PLWHIV) remains poorly studied in Kinshasa. The objective of this study was to describe the impact of tritherapy on the electrocardiogram of HIV-infected patients. Methods: This was a retrospective, descriptive, evaluative cohort with secondary analysis of a clinical cases serie of 155 HIV-infected patients under ART in the internal medicine department of University hospitals of Kinshasa (UHK) from 2013 to 2020. Results: The mean age of the patients was 54±11 years, with extremes ranging from 16 to 80 years, a sex ratio M/F=1. The dominant comorbidities were High blood pressure (HBP) at 23.4% and Pulmonary tuberculosis at 18. 8%. Dyspnea, HBP and lower limb edema were the main complaints, respectively 29.9%, 22.7% and 20.1%. The majority of patients were treated with TDF+3TC+EFV at 86.4% and a small proportion at 13.6% for TDF+3TC+ LPV/r. A total of 83.1% or 128 HIV-infected patients showed cardiac abnormalities on ECG. These were dominated by Left Ventricular Hypertrophy (LVH) 37%, sinus tachycardia 35% and repolarization disorders (subepicardial ischemia, subendocardial ischemia) 16.2%. With the TDF+3TC+LPV/r regimen, cardiac ECG abnormalities were more observed than with the TDF+3TC+EFV regimen with P<0.05; Right Ventricular Hypertrophy (RHV) at 40.4% with TDF+3TC+LPV/r regimen versus 4.7% with TDF+3TC+EFV P<0.001; myocardial ischaemia observed at 28.3% versus 11.2% with TDF+3TC+EFV regimen P=0.020. Conclusion: Electrocardiographic abnormalities are frequent and polymorphic to PLWHIV under ART (83.1%), often aggravated by protease inhibitors. The ECG should be used as a tool to screen for these abnormalities before and after 6 months of ART initiation.