SOURCE:

Faculty: Medicine
Department: Chemical Pathology

CONTRIBUTORS:

Ezeugwunne, I. P.
Ahaneku, J. E.
Onyenekwe, C. C.

ABSTRACT:

Introduction: Human Immnodeficiency Virus (HIV) is a lentivirus that breaks down the body’s immune system and gradually leads to Acquired Immune Deficiency Syndrome (AIDS), which is a fatal illness, prevalent in Africa. Patients infected with HIV have an increased risk of developing heart disease. Information on cardiac status in HIV infected subjects in Nigeria is scanty.
Aim: This study evaluated the Apolipoprotein (Apo) profile and other markers of cardiac function in HIV subjects on Antiretroviral therapy (ART) in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, South East, Nigeria.
Methodology: A total of 400 (M = 220, F = 180) subjects aged between 17 and 58 (38 ± 9) years were recruited by convenient sampling technique from patients that attended HIV Clinic, NAUTH, Nnewi from 2012 to 2014 for this study. The study design was a prospective study. Ethical approval was obtained from the Ethics Review Committee from NAUTH, Nnewi. The subjects were grouped based on WHO criteria for staging HIV infection and the presence or absence of malaria as follows: (1) Symptomatic HIV on Antiretroviral therapy (ART) (n = 100, M = 50, F = 50) of these, 50 were symptomatic HIV on ART with malaria co-infection. (2) Symptomatic HIV not on ART (n = 100, M = 64, F = 36) of these, 50 were symptomatic HIV not on ART with malaria co-infection. Thirty of the symptomatic HIV subjects not on ART without malaria co-infection were followed up on commencement of ART for 12 months. (3) Asymptomatic HIV subjects (n = 100, M = 57, F = 43) of these, 50 were asymptomatic HIV with malaria co-infection. (4) HIV seronegative control subjects (n = 100, M = 49, F = 51) of these, 50 were malaria positive. Enzyme linked Immunosorbent Assay (ELISA) was used for Apolipoproteins, Myoglobin and Troponin I. Spectrophotometric method was used for lipid profile, enzyme cardiac markers and Cyflow SL-Green for CD4 counts. Analysis of variance, Student t test, graph and correlation were used for data analyses.
Results: The results obtained showed that the mean level of serum Apo A2 (0.85 ±0.19), Apo B (2.31 ±0.72), Apo C2 (0.05 ±0.02) and Apo E (0.22 ±0.08) (g/L, respectively) in symptomatic HIV subjects before ART were significantly increased when compared with after 12 months ART (0.39 ±0.31), (1.59 ±0.49), (0.02 ±0.01) and (0.03 ±0.01) at p<0.05 respectively. Also, the total Creatine (T-CK), Creatine-isoform MB (CK-MB), myoglobin and Lactate Dehydrogenase (LDH) (IU/L, respectively) in symptomatic HIV subjects before ART were significantly increased when compared with after 12 months ART (p<0.05, in each case). But, the serum levels of total cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and CD4 counts in symptomatic HIV subjects before ART were significantly reduced when compared with after 12 months ART (p<0.05, in each case). There were increased serum levels of Apo C3 and CK-MB but decreased Apo E, HDL and CD4 counts in symptomatic HIV infected subjects on ART with malaria parasitaemia compared to those without malaria parasitaemia (P<0.05, in each case). There were increased serum levels of Apo E, TG and Myoglobin but decreased Apo C2 and HDL in symptomatic HIV infected subjects not on ART with malaria infection compared to those without malaria infection (P<0.05, respectively).
Conclusion: The reduction of serum apolipoproteins (Apo A2, Apo B, Apo C2, Apo E) and other cardiac markers (CK-T, CK-MB, myoglobin, LDH) in HIV subjects on ART suggest improved cardiac function. However, malaria endemicity poses a threat to the improved cardiac function as observed with increased serum levels of Apo C3, Apo E, CK-MB, myoglobin, and triglyceride in HIV malaria co-infection with or without ART. This calls for concern in the management of patients with HIV malaria co-infection.