Syndrome métabolique et risque cardiovasculaire chez des patients sous antirétroviraux à l’hôpital de jour de Bobo-Dioulasso (Burkina Faso)

Abstract

Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality of HIV but has led to an increasing metabolic cardiovascular risk. A cross-sectional study was conducted from May to September 2011 in Day Care Hospital for HIV-Patients of Bobo-Dioulasso. We included in this study 400 patients infected by HIVon antiretroviral therapy ≥ 6 months selected by a random draw. Metabolic syndrome was assessed according to the definitions of the IDF and ATP-III. The high risk of cardiovascular disease in 10 years was defined by a Framingham score ≥ 20%. The average age of our patients was 41.4 years [20-76]. 17% received an IP. The average duration of PI exposure was 35.5 months and 50.1 months for NNRTI. The prevalence of diabetes was 1.3% (95% CI: 0.5-3) and that of hypertension of 12.0 % (95% CI: 9.3-16). The prevalence of metabolic syndrome according to IDF was 10% (95% CI: 7.3-13.5) and the metabolic syndrome according to ATP-III 12.3% (95% CI: 9.3-16). The body mass index was higher (BMI 25.2 vs. 22.5 kg/m(2), p <10(-3) with ATPIII and BMI 26.6 vs. 22.4 kg/m(2), p <10(-3) with IDF), and duration exposure to ARVs longer in patients with metabolic syndrome regardless of the definition used (58.6 months vs 27.9 months). High cardiovascular risk was present in 1.8% (95% CI: 0.8 to 3.7) of our patients, all male more than half (n=4/7) of them were smoking. The choice of antiretroviral therapy must take into account its potential long-term toxicity. It should also strengthen supervision.

Features of Metabolic Syndrome and Its Associated Factors during Highly Active Antiretroviral Therapy in Ouagadougou (Burkina Faso)

“…1-3,7,9,11,13 It is also reported an association with a long exposure to ARV drugs. 1,5,10,13 But, beyond 54 months of treatment, our findings did not confirm this, strengthening observations on the early onset of metabolic disorders in African HIV-infected cohorts. 11,20 Conclusions sometimes differ on the role of initial immune deficiency.…”

Global Cardiovascular Risk of the HIV Positive Patients Receiving Antiretroviral Therapy in Brazzaville

“…In our study, the prevalence of high global CVR, although low compared to western series, attests to its increase over time in HIV+ patients on antiretroviral therapy. Similar proportions have been reported in some African series, notably in Benin [23] and Burkina Faso [21]. Overall, according to the literature data, the global CVR of PLHIV, particularly those treated with ARVs, appears to be higher than the one of HIV-positive patients without ARVs, and higher than the one of the general population [7].…”

A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population

“…In the 28 studies that reported on ART usage, 45–94% of the HIV-infected participants, were on ART [ 20 , 21 ] (median 76.2%). Of those on ART, 17.3–61.5% (median 37.4%) were on protease inhibitors (PIs) [ 22 , 23 ], 19.4% (median 43.4%) on non-nucleoside reverse transcriptase inhibitors (NNRTIs) [ 22 , 24 ], and 1.5–85.5% (median 77.0%) on nucleoside reverse transcriptase inhibitors (NRTIs) [ 21 , 25 ]. Very few studies provided information on the stage of the disease ( S4 Table ).…”

“…The overall MS prevalence rates by these criteria were 16.7% (95%CI, 14.6–18.8; I 2 = 92.1%, p- heterogeneity <0.001), 18.0% (95%CI: 14.0–22.4; I 2 = 95.8%, p<0.001) and 24.6% (95%CI: 20.6–28.8; I 2 = 95.8%, p<0.001), respectively. The prevalence ranges were 7.2% [ 26 ] to 31% [ 27 ] (ATPIII 2001), 7.8% [ 28 ] to 43.2% [ 29 ] (IDF 2005) and 12.3% [ 22 ] to 52% [ 30 ] (ATPIII 2004–2005).…”

“…The relation between CD4 count and MS was unclear with some studies reporting a direct link [ 43 , 44 ] while others demonstrate the inverse [ 45 ] or no association [ 46 , 47 ]. However, these findings were based on only seven studies and did not report the viral loads [ 13 , 17 , 22 , 40 , 42 , 48 , 49 ]. Without such information it is difficult to draw conclusions on this relationship.…”