Prevalence of Structural Heart Disease Detected By Echocardiography among Adults Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Eastern Nepal

Abstract

Background: Improved survival on antiretroviral therapy has shifted morbidity in human immunodeficiency virus infection towards non-communicable cardiac disease, yet echocardiographic data from South Asia remain sparse.

Aims/Objectives: To determine the prevalence of structural heart disease, comprising dilated cardiomyopathy and valvular heart disease, and its association with age, sex and CD4 count.

Methodology: A hospital-based cross-sectional study enrolled 126 consecutive adults on antiretroviral therapy at a tertiary centre in eastern Nepal between August 2018 and July 2019. Those with hypertension, alcohol dependence, cardiotoxic drug exposure or pre-existing cardiac or systemic disease were excluded. All underwent transthoracic echocardiography and CD4 estimation.

Results: Structural heart disease was present in 19 (15.1%) participants: dilated cardiomyopathy in 14 (11.1%) and valvular heart disease in 7 (5.6%). Prevalence did not differ across age groups (χ² = 0.94, p = 0.627) or by sex (11/64 men, 17.2%, versus 8/62 women, 12.9%; odds ratio 1.40, 95% CI 0.52–3.76, p = 0.502). Mean CD4 count was similar in affected and unaffected participants (627 ± 309 versus 551 ± 248 cells/µL; t = 1.18, p = 0.239).

Conclusions: One in seven treated adults had unsuspected structural heart disease, independent of age, sex and CD4 count, supporting routine echocardiographic screening.