AIMS: The contemporary impact of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic on heart disease in South Africa (>5 million people affected) is unknown. The Heart of Soweto Study provides a unique opportunity to identify the contribution of cardiac manifestations of this epidemic to de novo presentations of heart disease in an urban African community in epidemiological transition. METHODS AND RESULTS: Chris Hani Baragwanath Hospital services the >1 million people living in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of heart disease presenting to the Cardiology Unit during 2006-08. We describe all cases where HIV/AIDS was concurrently diagnosed. Overall, 518 of 5328 de novo cases of heart disease were identified as HIV-positive (9.7%) with 54% of these prescribed highly active anti-retroviral therapies on presentation. Women (62%) and Africans (97%) predominated with women being significantly younger than men 38 ± 13 vs. 42 ± 13 years (P = 0.002). The most common primary diagnosis attributable to HIV/AIDS was HIV-related cardiomyopathy (196 cases, 38%); being prescribed more anti-retroviral therapy (127/196 vs. 147/322; odds ratio 2.85, 95% confidence interval 1.81-3.88) with higher viral loads [median 110 000 (inter-quartile range 26 000-510 000) vs. 19 000 (3200-87 000); P = 0.018] and a lower CD4 count [median 180 (71-315) vs. 211 (96-391); P = 0.019] than the rest. An additional 128 cases (25%) were diagnosed with pericarditis/pericardial effusion with a range of other concurrent diagnoses evident, including 42 cases (8.1%) of HIV-related pulmonary arterial hypertension. Only 14 of all 581 cases of coronary artery disease (CAD) (2.4%, mean age 41 ± 13 years) were confirmed HIV-positive. CONCLUSION: Cardiac manifestations of HIV/AIDS identified within this cohort were relatively infrequent. While HIV-related cardiomyopathy and pericardial disease remain important targets for early detection and treatment in this setting, HIV-related cases of CAD remain at historically low levels.
AIMS: The contemporary impact of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic on heart disease in South Africa (>5 million people affected) is unknown. The Heart of Soweto Study provides a unique opportunity to identify the contribution of cardiac manifestations of this epidemic to de novo presentations of heart disease in an urban African community in epidemiological transition. METHODS AND RESULTS: Chris Hani Baragwanath Hospital services the >1 million people living in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of heart disease presenting to the Cardiology Unit during 2006-08. We describe all cases where HIV/AIDS was concurrently diagnosed. Overall, 518 of 5328 de novo cases of heart disease were identified as HIV-positive (9.7%) with 54% of these prescribed highly active anti-retroviral therapies on presentation. Women (62%) and Africans (97%) predominated with women being significantly younger than men 38 ± 13 vs. 42 ± 13 years (P = 0.002). The most common primary diagnosis attributable to HIV/AIDS was HIV-related cardiomyopathy (196 cases, 38%); being prescribed more anti-retroviral therapy (127/196 vs. 147/322; odds ratio 2.85, 95% confidence interval 1.81-3.88) with higher viral loads [median 110 000 (inter-quartile range 26 000-510 000) vs. 19 000 (3200-87 000); P = 0.018] and a lower CD4 count [median 180 (71-315) vs. 211 (96-391); P = 0.019] than the rest. An additional 128 cases (25%) were diagnosed with pericarditis/pericardial effusion with a range of other concurrent diagnoses evident, including 42 cases (8.1%) of HIV-related pulmonary arterial hypertension. Only 14 of all 581 cases of coronary artery disease (CAD) (2.4%, mean age 41 ± 13 years) were confirmed HIV-positive. CONCLUSION: Cardiac manifestations of HIV/AIDS identified within this cohort were relatively infrequent. While HIV-related cardiomyopathy and pericardial disease remain important targets for early detection and treatment in this setting, HIV-related cases of CAD remain at historically low levels.
Authors: K Mulligan; C Grunfeld; V W Tai; H Algren; M Pang; D N Chernoff; J C Lo; M Schambelan Journal: J Acquir Immune Defic Syndr Date: 2000-01-01 Impact factor: 3.731
Authors: Simon Stewart; David Wilkinson; Anthony Becker; Deborah Askew; Lucas Ntyintyane; John J V McMurray; Karen Sliwa Journal: Int J Cardiol Date: 2006-02-07 Impact factor: 4.164
Authors: T C Wu; M C Pizzorno; G S Hayward; S Willoughby; D A Neumann; N R Rose; A A Ansari; W E Beschorner; K L Baughman; A Herskowitz Journal: AIDS Date: 1992-08 Impact factor: 4.177
Authors: Nina Friis-Møller; Peter Reiss; Caroline A Sabin; Rainer Weber; Antonella d'Arminio Monforte; Wafaa El-Sadr; Rodolphe Thiébaut; Stephane De Wit; Ole Kirk; Eric Fontas; Matthew G Law; Andrew Phillips; Jens D Lundgren Journal: N Engl J Med Date: 2007-04-26 Impact factor: 91.245
Authors: Sharon A Riddler; Ellen Smit; Stephen R Cole; Rui Li; Joan S Chmiel; Adrian Dobs; Frank Palella; Barbara Visscher; Rhobert Evans; Lawrence A Kingsley Journal: JAMA Date: 2003-06-11 Impact factor: 56.272
Authors: Joshua A Walker; Andrew D Miller; Tricia H Burdo; Michael S McGrath; Kenneth C Williams Journal: J Acquir Immune Defic Syndr Date: 2017-04-15 Impact factor: 3.731
Authors: Matthew J Feinstein; Milana Bogorodskaya; Gerald S Bloomfield; Rajesh Vedanthan; Mark J Siedner; Gene F Kwan; Christopher T Longenecker Journal: Curr Cardiol Rep Date: 2016-11 Impact factor: 2.931