Table 5.

Summary of Risk Factors for Cardiac Dysfunction in HIV-Infected Children in Sub-Saharan Africa

Risk Factor	Description / Key Findings	Supporting Studies
Advanced HIV Disease (WHO Stage III/IV) & Low CD4 Count	Severe immunosuppression and advanced disease strongly linked to LVSD and other cardiac abnormalities. LVSD prevalence highest among children with AIDS (81%), compared to milder HIV (27%). Lower CD4 count independently predicts dysfunction.	8,9,12,26,34
Older Age & Longer Duration of HIV Infection	LVSD and other cardiac abnormalities appear to be more common with age and longer duration of untreated infection. Adolescents show higher rates than younger children.	2,10,12,28,33
Shorter Duration on ART (Late ART Initiation)	Early, sustained ART appears to be associated with lower LVSD prevalence. Later or interrupted ART is linked with higher LVSD rates.	9,12,24,29
Malnutrition, Low BMI, Growth Failure	Growth failure, low weight-for-age, and low BMI are associated with higher LVSD prevalence.	9,12,23,29,34
Anaemia (Low Haemoglobin)	Children with very low haemoglobin are more likely to develop LVSD.	9,12, 29,34
ART Drug-Specific Effects	Zidovudine exposure is associated with abnormal LV mass and impaired strain.	2,10,28
Long-Standing Viral Replication / Poor Viral Control	Poorly controlled viral load contributes to myocardial inflammation and dysfunction; long-term ART suppression appears to be associated with lower reported prevalence.	10,12,28,36,31
Sex (Male Gender)	Some studies noted higher LV mass or LVSD among males, although findings were inconsistent.	2,10
Socio-economic & Environmental Stressors	Poverty, limited access to healthcare, and late diagnosis indirectly increase risk of severe disease and associated cardiac involvement.	8,9,27