title: Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: Faculty of Health Sciences,  Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Cape Town,  South Africa.
authors: Karen
authors: K
authors: Sliwa
authors: Melinda J
authors: MJ
authors: Carrington
authors: Anthony
authors: A
authors: Becker
authors: Friedrich
authors: F
authors: Thienemann
authors: Mpiko
authors: M
authors: Ntsekhe
authors: Simon
authors: S
authors: Stewart
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D009202:Cardiomyopathies / Q000453:epidemiology / Q000821:virology; D015331:Cohort Studies; D058872:Epidemics / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006331:Heart Diseases / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology; D014504:Urban Health; D055815:Young Adult