title: Patterns of cardiovascular disease in a group of HIV-infected adults in Yaoundé, Cameroon.
abstract: BACKGROUND
  Cardiovascular disease is an increasingly important issue in human immunodeficiency viral (HIV)-infected individuals. There is dearth of information on the patterns of cardiovascular disease especially in sub-Saharan Africa (SSA) patients. This study reports on the clinical, biological, electrocardiographic and echocardiographic characteristics of a group of HIV-infected patients presenting with symptoms of heart disease in Yaoundé, Cameroon.
  
  
  METHODS
  This was a cross-sectional study conducted at the Yaoundé Central Hospital and Jamot Hospital. Consenting HIV-infected adults aged ≥18 years with symptoms suggestive of heart disease were consecutively recruited between February and July 2014. All participants underwent a complete clinical examination; biological analyses including CD4 cell counts, fasting blood glucose, and serum lipids, resting electrocardiography and cardiac ultrasound, and a venous ultrasound where necessary.
  
  
  RESULTS
  Forty four subjects (21 men) were included. Their mean age was 48 (SD 13) years. Thirty patients (68.2%) were in WHO clinical stages 3 and 4 of HIV infection, 27 (61.4%) had a CD4 cell count <200/mm(3), and 31 (70.5%) were on antiretroviral therapy (ART). Hypertension (43.2%, n=19) was the most frequent cardiovascular risk factor; and dyslipidemia which was found in 17 subjects (38.6%) was significantly associated with ART (48.4% vs. 15.4%, P=0.04). Only men where smokers (23% vs. 0%, P=0.019). Exertional dyspnea (86.4%, n=38) and cough (59.1%, n=26) were the most frequent symptoms, and the clinical presentation was dominated by heart failure (75%, n=33). The most frequent echocardiographic abnormalities were pericardial effusion (45.5%, n=20) and dilated cardiomyopathy (22.7%, n=10). Dilated cardiomyopathy was significantly associated with CD4 cell counts <200/mm(3) (100%, P=0.003). Primary pulmonary hypertension (PH) rate was 11.4% (n=5) and all cases occurred at CD4 cell counts ≥200/mm(3) (P=0.005). The most frequent electrocardiographic abnormalities were abnormal repolarization (59%, n=26) and sinus tachycardia (56.8%, n=25).
  
  
  CONCLUSIONS
  Cardiovascular risk factors such as hypertension and dyslipidemia are common in HIV-infected adults with heart disease in our milieu. Advanced HIV infection in adults is associated with a high rate of symptomatic heart disease, mostly effusive pericarditis and dilated cardiomyopathy. Primary PH occurred in less advanced HIV disease.
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Alain Patrick
authors.initials: AP
authors.lastname: Menanga
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Christelle Kougang
authors.initials: CK
authors.lastname: Ngomseu
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Ahmadou M
authors.initials: AM
authors.lastname: Jingi
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Brigitte Molu
authors.initials: BM
authors.lastname: Mfangam
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Jean Jacques N
authors.initials: JJ
authors.lastname: Noubiap
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Marie Ntep
authors.initials: MN
authors.lastname: Gweth
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Kathleen Ngu
authors.initials: KN
authors.lastname: Blackett
authors.affiliation: 1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; 2 Department of Medicine, Yaoundé General Hospital, Yaoundé, Cameroon ; 3 Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa ; 4 Medical Diagnostic Center, Yaoundé, Cameroon ; 5 Department of Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon ; 6 Department of Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kingue
keywords: Cameroon; Cardiovascular disease; HIV/AIDS; echocardiography; electrocardiography