Abstract:
This research project compared the influence of the CD4 cell count,
the viral load and antiretroviral therapy (ARn on the left ventricle
ejection fraction (LVEF). The purpose was to see what the
relationship between the variables was in an attempt to find a point in
the course of the HIV/AIDS disease where it is necessary to do an
echocardiogram on these patients to evaluate the LVEF. All the data
of the variables were included against the inclusion and exclusion
criteria. An echocardiogram was done on all those HIV/AIDS
diagnosed patients who gave their consent to evaluate the LVEF. The
patients then went for their usual blood tests and ART was given if it
was indicated. The findings show that there was a direct proportional
relationship between the LVEF and the CD4 cell count, and an indirect
proportional relationship between the viral load and the LVEF. The
prevalence of a below normal LVEF was mostly found in patients
whose CD4 cell count was below or equal to 100 cells/ml and/or the
viral load above or equal to 100 000 RNA copies/ml. The majority of
patients whose LVEF was below normal and whose viral load was
equal to or below 100 000 RNA copies/ml were on antiretroviral
therapy. When the viral load exceeded the cut-off point of 100 000
RNA copies/ml, the patients who were not on ART with a below normal LVEF exceeded those who were on ART. The majority of
patients with a low CD4 cell count whose LVEF was below normal
were not on antiretroviral therapy. It was also found that the ART had
a direct positive effect on the CD4 cell count and the viral load, and
indirectly on the LVEF. Therefore, because of the relationship
between the CD4 cell count and the LVEF and the viral load and the
LVEF, ART had an indirect effect on the LVEF via the CD4 cell count
and/or the viral load. This means that if there was an increase in the
CD4 cell count due to the ART, then one could expect to see a rise in
the LVEF because of the direct proportional relationship between the
CD4 cell count and the LVEF. If the ART led to a decrease in the viral
load, then one could expect that the LVEF would increase due to an
indirect proportional relationship between the viral load and the LVEF.
Successful antiretroviral therapy had a positive effect on the CD4 cell
count and the viral load, and an indirect positive effect on the LVEF
(via the CD4 cell count and/or the viral load).
To conclude, the treating physician of ~n adult HIV/AIDS patient
should consider an echocardiogram on all these patients when the
CD4 cell count falls below 100 copies/ml, and/or when the viral load
exceeds 100 000 RNA copies/ml in order to identify those patients
who have left ventricular dysfunction and who might therefore benefit
from treatment with appropriate medication.
