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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort
European Heart Journal, Volume 33, No. 7, Year 2012
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Description
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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011.
Authors & Co-Authors
Sliwa, Karen S.
South Africa, Cape Town
Faculty of Health Sciences
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
South Africa, Observatory
Groote Schuur Hospital
Carrington, Melinda J.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Australia, Melbourne
Baker Heart and Diabetes Institute
Becker, Anthony C.
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Thienemann, Friedrich
South Africa, Observatory
Groote Schuur Hospital
South Africa, Cape Town
University of Cape Town
Germany, Berlin
Charité – Universitätsmedizin Berlin
Ntsekhe, Mpiko
South Africa, Observatory
Groote Schuur Hospital
Stewart, Simon D.
South Africa, Cape Town
Faculty of Health Sciences
South Africa, Johannesburg
Chris Hani Baragwanath Hospital
Australia, Melbourne
Baker Heart and Diabetes Institute
Statistics
Citations: 148
Authors: 6
Affiliations: 6
Identifiers
Doi:
10.1093/eurheartj/ehr398
ISSN:
0195668X
e-ISSN:
15229645
Research Areas
Health System And Policy
Infectious Diseases
Noncommunicable Diseases
Study Design
Cohort Study
Case-Control Study
Study Locations
South Africa
Participants Gender
Male
Female