Echocardiographic cardiac abnormalities among HIV-exposed uninfected infants in North-Central Nigeria: a comparative cross-sectional study

The successful scale-up of prevention of mother-to-child transmission (PMTCT) programmes has led to a rapidly growing population of HIV-exposed uninfected (HEU) infants worldwide. Although these infants remain HIV-negative, emerging evidence suggests that in-utero exposure to maternal HIV infection and antiretroviral therapy may influence cardiovascular development. However, data on echocardiographic cardiac abnormalities among HEU infants in sub-Saharan Africa, particularly Nigeria, remain limited. A comparative cross-sectional study was conducted among 312 infants, comprising 156 HEU and 156 HIV-unexposed infants aged 0–52 weeks attending the Federal Medical Centre, Bida, North-Central Nigeria.Standard transthoracic echocardiography was performed to assess cardiac structure and function. Measurements were evaluated against both Nigerian and Detroit paediatric reference values, while cardiac abnormalities were classified using Detroit reference standards. Echocardiographic parameters were compared between groups using independent-samples t-tests and Pearson's χ² or Fisher’s exact tests, as appropriate. Factors associated with echocardiographic cardiac abnormalities were identified using bivariable and multivariable logistic regression analyses in the HEU group. Echocardiographic cardiac abnormalities were more prevalent among HEU infants than HIV-unexposed infants (66.7% vs. 2.6%; p < 0.001). Compared with HIV-unexposed infants, HEU infants had greater interventricular septal and left ventricular posterior wall thicknesses, as well as higher fractional shortening and ejection fraction values. Structural cardiac lesions were uncommon in both groups. Among HEU infants, maternal CD4 count < 500 cells/mm³ (aOR 3.29, 95% CI 1.51–7.18; p = 0.003) and maternal viral load ≥ 200 copies/mL (aOR 3.07, 95% CI 1.30–7.25; p = 0.011) were independently associated with increased odds of echocardiographic cardiac abnormalities, whereas multiparity was independently associated with reduced odds (aOR 0.22, 95% CI 0.06–0.84; p = 0.027). HEU infants demonstrated a substantially higher burden of predominantly subclinical echocardiographic cardiac abnormalities than HIV-unexposed infants. Poor maternal immunological and virological status was independently associated with these abnormalities. Longitudinal studies are needed to determine their persistence and long-term clinical significance before routine echocardiographic screening of HEU infants can be recommended.