Cardiac Manifestations in Patients with HIV Infection and their Correlation with CD4 Count: A Cross-Sectional Study from the Bundelkhand Region of Uttar Pradesh, India

Background: Cardiac involvement in HIV infection ranges from silent echocardiographic changes to overt heart failure and generally worsens with immunosuppression. No data exist on its pattern among people living with HIV in the Bundelkhand region of Uttar Pradesh. Aims and Objective: To describe cardiac manifestations in HIV-positive adults, compare them with HIV-negative controls and examine their relationship with CD4 count. Materials and Methods: In this hospital-based cross-sectional study, 100 HIV-positive adults and 100 age- and sex-matched HIV-negative controls at a tertiary hospital in Jhansi underwent clinical examination, electrocardiography, chest radiography and Doppler echocardiography. CD4 count, WHO stage and antiretroviral therapy (ART) status were recorded for HIV-positive patients. Groups were compared with the chi-square test, t-test, analysis of variance and correlation coefficients. Results: At least one cardiac abnormality was present in 38% of HIV-positive and 30% of HIV-negative patients (p=0.234). Diastolic dysfunction (60% vs 50%), arrhythmia (11% vs 5%), left ventricular dysfunction (13% vs 10%) and radiographic cardiomegaly (6% vs 1%, p=0.050) were more frequent with HIV. Pericardial effusion occurred in 12% of each group, always in patients with a tuberculosis history (p<0.001). Among HIV-positive patients it rose from 6.8% at CD4 >500 cells/µL to 30.0% at CD4 <200 cells/µL (p=0.015). Mean ejection fraction did not differ by HIV status, CD4 category, WHO stage or ART regimen, and CD4 count did not correlate with ejection fraction (r=0.086, p=0.395). Conclusion: Cardiac involvement in HIV-positive patients here is mainly pericardial and diastolic, with preserved systolic function. Pericardial effusion is linked to low CD4 count and tuberculosis, and such patients warrant echocardiographic screening.