Interaction Between Hiv/aids and Infective Endocarditis in Africa: a Retrospective Case Report and Literature Review
Year: 2009
Type: dissertation
Abstract: In Africa, infective endocarditis (IE) is still a disease of young adults with underlying \nrheumatic heart disease (RHD). As of 2006, almost two-thirds of all persons infected \nwith human immunodeficiency virus (HIV) are living in sub-Saharan Africa. Southern \nAfrica thus remains the epicentre of the global HIV epidemic. The HIV sero-prevalence \ndata reported in Southern Africa are as high as 20% - 30% of the adult population aged \nbetween 15 and 49 years. In South Africa, the prevalence of HIV among adults aged 15 - \n49 is 18.8%. Based on a simple extrapolation, there is a higher possibility of encountering \na significant number of patients infected with HIV and underlying RHD with IE in \nSouthern Africa than in any other part of the world. In Africa because both HIV and \nvalvular heart disease are relatively common, the co-existence of the two conditions in \nindividual patients is not rare. \nDespite the major advances in diagnosis and management of this classical disease, the \noverall mortality rates for both native-valve and prosthetic-valve endocarditis remain as \nhigh as 20 to 25 percent after 1 year and at 50% after 10 years. However, the mortality \nrate varies, depending on a number of factors, such as: \n• the causative microorganism \n• the presence of complications \n• the development of perivalvular extension or a myocardial abscess \n• neurological events \n• the existence of conditions such as congestive heart failure \n• renal failure \n• severe immunosuppression due to HIV infection in intravenous drug abusers \n• the use of combined medical therapy and surgical therapy in appropriate patients. \nvi \nThe clinical outcome of infective endocarditis in HIV patients is poor, severe \nimmunodeficiency in IVDAs with IE has been reported to be associated with poor \noutcome. However, such an association has never been documented in non-IVDAs, \nparticularly in Africa, where the expected majority patients with HIV and IE are non- \nIVDAs. \nThe clinical profile including bacteriology of infective endocarditis in HIV patients is \ndifferent from HIV uninfected patients. The clinical impact of the HIV epidemic on \ninfective endocarditis in Africa has not been elucidated in the world literature and there \nis, moreover, a paucity of literature describing this clinical entity of HIV and IE in Africa. \nObjective \nThe objective of this study was to highlight the co-existence of infective endocarditis in \nHIV positive, non-intravenous drug abuse in South Africa and Africa by: reporting three \ncases admitted at the researcher’s institution within a period of two months; and \nundertaking a literature review. \nMethods \nThis was a retrospective case report and literature review study of IE in HIV infected \npatients. Three HIV positive patients with IE and with or without underlying chronic \nrheumatic heart disease were reported. The patients were admitted at the researcher’s \ninstitution within a period of two months. All three patients did not report intravenous \ndrug abuse. However, all patients died within a short period of admission to the hospital. \nThe systematic review of cases published in the literature was delivered from MEDLINE \nSEARCH from January 1985 to December 2006. The following key words were used: \nHuman Immunodeficiency Virus, Acquired Immunodeficiency Syndrome, \nRheumatic Heart Disease, Infective Endocarditis, and Intravenous Drug Abusers \nand Non-Intravenous Drug Abusers. Most of the articles were identified in English; \nwhere articles were identified in Spanish and French, only abstracts were used. \nvii \nLiterature emanating from Africa was emphasized. In addition, the references quoted in \nthis study were reviewed for relevance on the topic. \nResults \nThree patients with definitive IE and infected with HIV were reported: one patient was \nwithout underlying chronic rheumatic valvular heart disease and two showed underlying \nchronic rheumatic valvular heart disease. There are few reported studies of IE not related \nto intravenous drug abuse in HIV infected patients in the literature, which is probably \nattributable to the reported low prevalence of IE in this sub-group of patients. Most of \nthese published studies are limited to a series of case reports and very little data or reports \noriginate from Africa. \nConclusion \nThe clinical pattern of IE in HIV positive patients who are not IVDAs is not well \ndescribed in literature. However, in this anecdotal case report, the three patients studied \nretrospectively had a poor outcome. Based on this anecdotal report of three cases \ndescribed, if an extrapolation was done from these numbers and a prospective analysis \nperformed, we would observed a substantial number of non-IVDU cases with infective \nendocarditis and HIV/AIDS in Africa. The literature review in its current form may shed \nsome light on HIV and IE in non-IVDU patients, but doesn’t specifically address the \nissue of the potential co-existence of HIV and IE in Africa. Given the high prevalence \nboth HIV/AIDS and rheumatic valvular heart disease in Africa, in future, we are more \nlikely to see a significant proportion of patients with IE and underlying rheumatic \nvalvular heart disease who are coincidentally HIV infected. There is a useful need for \nprospective studies describing the prevalence and outcome and for subsequently defining \nthe management of this condition in Africa.
Author: Robert Sostenes Mvungi
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1494191505