Heart involvement and HIV infection in African patients: determinants of survival

In Africa, recent studies have reported that HIV may exhibit a cardiac tropism. The purpose of this study was to determine if clinical features, sex, age at onset, biological or echocardiographic variables have any influence on survival of African HIV-infected patients and AIDS progression. One hundred and fifty seven consecutive HIV-seropositive patients without cardiac lesions and no other AIDS-defining illnesses underwent physical, electrocardiographic and Doppler echocardiographic examinations at the Heart of Africa Cardiovascular Centre, Lomo Medical, Kinshasa, Congo, between July 1987 and July 1994. Odds ratios were calculated to assess the influence of potential risk factors on cardiac lesions, opportunistic diseases, and death outcomes. Cardiac lesions had occurred in 87 patients (55%) during 7-year follow up. The onset of heart involvement was associated with a protection against opportunistic comorbidity. In multiple regression model, cardiac mass/volume ratio, body temperature, deceleration time, body mass index and socio-economic status were each independently associated with AIDS outcome. In a multivariate analysis the lowest socioeconomic status and the pericardial effusion were the independent predictors of death. The higher CD4 count and cardiac lesions outcome were connected with slower progression to AIDS. Dilated cardiomyopathy was associated with longer survival.