Infective endocarditis in central South Africa in the HIV era- a surgical perspective

Introduction: Infective endocarditis (IE) remains an evolving disease with a persistently high mortality and morbidity. In Africa, it is predominantly a disease of the young in contrast to the developed world. South Africa represents a very high prevalence of HIV at 21.67% of global HIV infections. Other factors in South Africa include the high prevalence of rheumatic valvular heart disease, low socio-economic status and poverty makes the patient population completely different from the developed world. The primary aim was to determine the influence of HIV infection on infective endocarditis patients in central South Africa. The secondary aim was to compare the HIV positive patients and HIV negative patients in the context of this disease. Objectives: To determine the demographics, presentation, indication for surgery, microorganisms, and outcomes of HIV positive versus HIV negative patients presenting with Infective endocarditis. Methods: Retrospective, analytical cohort study that reviewed the records of adult patients who were tested for HIV and treated surgically for infective endocarditis between 2009 to 2019. Data was compared between the two groups using chi-square or Fisher exact tests for categorical variables. Median and interquartile ranges were used for continuous variables and frequencies and proportions for categorical variables. Significance was set as p < 0.05. Results: From the 141 IE patients who underwent surgery for IE, 105 patients were tested for HIV, 31% (n=33) tested positive. The mean age for both groups was comparable 38.87 versus 39.51 years. Eighty-eight percent (n=29) of positive patients were on HAART. In both groups, there was a male preponderance, 55% vs 46% and 56% vs 44% respectively. The majority of HIV positive (91%) and negative patients (71%) were of African descent, more than 50% of both groups presented with NYHA III&IV, both groups had a medium-high risk of developing IE (HIV (+) 72%; HIV (-) 62%). Prevention of embolization