Factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania

Abstract

Cardiovascular diseases, including heart failure are a known complication of Human Immunodeficiency Virus (HIV) infection globally. The objective of this study was to describe factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania. Clinical, laboratory and echocardiographic assessment was performed in all HIV-infected patients presenting with cardiac complaints at the medical department, Muhimbili National Hospital between September 2009 and April 2010. HF was diagnosed clinically and confirmed by echocardiography. Of the 102 HIV-infected patients with cardiac complaints 50 (49%) were in HF. Commonest causes of HF were hypertensive heart disease, pulmonary hypertension and dilated cardiomyopathy. In multivariate analysis male gender (OR 4.03), low education (OR 4.91), previous history of tuberculosis (OR 3.01), and low haemoglobin (OR 0.83), were independently associated with the diagnosis of HF (p<0.05 for all). In conclusion, heart failure is common in HIV-infected patients with cardiac complaints, and is associated with both modifiable and non-modifiable factors.

Cardiovascular morbidity and mortality among persons diagnosed with tuberculosis: A systematic review and meta-analysis

“…The finding of elevated CVD morbidity and mortality from both the per-protocol and post hoc meta-analyses were robust to inclusion/exclusion of: estimates from studies enrolling populations requiring a medical condition beyond TB (people living with HIV [31,32], hospitalized persons [15], and non-chest surgery patients [33]); estimates that were not adjusted for…”

“…To assess the robustness of the findings from our per-protocol meta-analysis, we conducted three sensitivity analyses: first, we removed estimates from studies that required a medical condition other than TB for inclusion (i.e., HIV infection [31,32], and non-chest surgery [33]); second, we excluded estimates that were not adjusted for risk factors beyond age and sex; and third, we removed one estimate that was of extra-pulmonary TB. Two sub-group analyses were conducted, one analyzing only CVD mortality, and one analyzing only CVD events (acute myocardial infarction, ischaemic stroke, or cerebrovascular event).…”

“…Another LTBI study with coronary artery stenosis (CAS) as the outcome, measured via percutaneous coronary angiography, used both tuberculin skin test (TST>10mm) and QuantiFERON-TB Gold positive as their exposure assessment [38]. People with HIV were variously: included in study populations (two studies included only people living with HIV in their analytic samples [31,32]), excluded from study populations [15,16,38], or included as a proportion of the study population. The models and types of risk estimates varied considerably between studies but all were appropriate to answer our review question.…”

“…For the post hoc meta-analysis, we removed the studies of latent TB [14,37]. We then pooled studies reporting MACE [31,41]. For this analysis, in place of Wang et al (outcome: peripheral arterial disease) [41], we substituted the second largest study from Taiwan, which analyzed AMI and unstable angina as the combined endpoint of acute coronary syndrome [46].…”

“…risk factors beyond age and sex [15,16,31,32,41]; and the estimate from a study of extrapulmonary TB and CVD mortality [40] with asymmetrical confidence intervals (Table 3). Subgroup analyses showed lower pooled RRs from the per-protocol meta-analysis, for both CVD mortality [32,36,39,40], and CVD events [15,16,35], yet were consistent with the post hoc meta-analysis pooled RR, although the CVD events sub-group analysis was not statistically significant (p = 0.1557).…”