Reversibility of echocardiographic changes in human immunodeficiency virus infection and acquired immune deficiency syndrome

Background: Echocardiographic abnormalities in patients with human immunodeficiency virus (HIV) infection have been well documented. However, their relation with CD4 count and reversibility with treatment has not been studied prospectively. We studied prevalence and nature of echocardiographic abnormalities in HIV-infected patients and prospectively correlated with their CD4 count. Materials and Methods: We studied 108 consecutive patients with HIV infection. Baseline CD4 cell count and two-dimensional echocardiography were done. The study participants were categorized into two; one with CD4 count <100/mm3 and the other with CD4 >100/mm3. They were followed up quarterly with CD4 count and repeat echocardiography for 1 year. Results: Abnormalities on echocardiography were noted in 36 of 108 patients (33.3%). Thirty-two patients (29.6%) were detected to have diastolic dysfunction of the left ventricle, ten patients (9.25%) left ventricular (LV) systolic dysfunction and eight patients (7.4%) pericardial effusion. Abnormalities were more frequent when CD4 was <100/c.mm. LV systolic dysfunction (and dilated cardiomyopathy) occurred exclusively in patients with CD4 <100/c.mm. As the CD4 count improved with treatment, many of the echocardiographic changes reversed. Conclusions: HIV-infected individuals frequently have asymptomatic and subclinical cardiac involvement. LV diastolic dysfunction, systolic dysfunction, and pericardial effusion are more common with lower CD4 cell count. With treatment, as the CD4 count improved, there was reversibility of systolic dysfunction, diastolic dysfunction, and pericardial effusion.