Mukeba-Tshialala D, Nachega J B, Mutombo-Tshingwali M, Arendt V, Gilson G, Moutschen M
Faculté de médecine, université de Mbuji-Mayi, Mbuji-Mayi, Kasaï-Oriental, RDC, Congo.
CRP-Santé, CIEC, 1 A-B, rue Thomas-Edison, 1445, Strassen, Luxembourg.
Bull Soc Pathol Exot. 2017 Dec;110(5):301-309. doi: 10.1007/s13149-017-0561-2. Epub 2017 Jun 16.
Little is known about the major cardiovascular risk factors in HIV-infected as compared to the HIV-uninfected patients in the Democratic Republic of Congo (DR Congo). We determined the prevalence of hypertension, obesity (BMI ≥ 30 kg/m), total cholesterol > 200 mg/dl, HDLcholesterol &≤ 40 mg/dl, and glycemia > 126 mg/dl. We also calculated the average and/or median of total cholesterol, HDL-cholesterol, and glycemia among HIV-infected and HIV-uninfected patients.We conducted a cross-sectional study that enrolled 592 HIV-uninfected and 445 HIV-infected patients of whom 425 (95.5%) were on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine. Clinical and laboratory data of the patients were collected. The results were analyzed by chi-square, t-student, and Wilcoxon rank sum tests. 11.5% of HIV-infected patients had an average blood pressure suggesting hypertension versus 10.6% of HIV-uninfected (P = 0.751). But in absolute value, HIVinfected patients had a median of diastolic blood pressure of 90 mmHg versus 85 mmHg of HIV-uninfected (P < 0.001). 4.04% of HIV-infected patients had a BMI suggesting obesity versus 6.08% of HIV-uninfected patients (P = 0.187). For fasting glucose: 2.50% of HIV-infected patients versus 4.20% of HIV-uninfected patients had a serum fasting glucose suggesting diabetes (P<0.176). 11.9% of HIV-infected patients had a total cholesterol greater than 200 mg/dl versus 7.4% of HIVuninfected patients (P=0.019). For HDL-cholesterol: 36.40% of HIV-infected patients had a serum fasting ≤ 40 mg/dl versus 15.70% of HIV-uninfected patients (P < 0.001). HIV-infected patients had a median fasting total cholesterol higher (140 mg/ dl) thanHIV-uninfected patients (133mg/dl) [P=0.015].HIVuninfected patients had a median fasting HDL-cholesterol higher (58.5 mg/dl) than HIV-infected patients (49 mg/dl) [P < 0.001]. HIV-infected women were more likely to have a higher mean of total cholesterol: 147.70 #x00B1; 52.09 mg/dl versus 135.72 ± 48.23 mg/dl for the HIV-infected men (P = 0.014) and of HDL-cholesterol: 55.80 ± 30.77 mg/dl versus 48.24 ± 28.57mg/dl for the HIV-infected men (P = 0.008). In this study population, prevalence of hypertension was elevated in HIVinfected versus HIV-uninfected patients. Being HIV positive on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine was associated with high prevalence of total cholesterol > 200 mg/dl and HDL-cholesterol ≤ 40 mg/dl. Proactive screening and prompt management of dyslipidemia and hypertension in this population should be a priority.
与刚果民主共和国未感染艾滋病毒的患者相比,人们对感染艾滋病毒患者的主要心血管危险因素知之甚少。我们测定了高血压、肥胖(体重指数≥30kg/m²)、总胆固醇>200mg/dl、高密度脂蛋白胆固醇≤40mg/dl和血糖>126mg/dl的患病率。我们还计算了感染艾滋病毒和未感染艾滋病毒患者的总胆固醇、高密度脂蛋白胆固醇和血糖的平均值和/或中位数。我们进行了一项横断面研究,纳入了592名未感染艾滋病毒的患者和445名感染艾滋病毒的患者,其中425名(95.5%)正在接受基于司他夫定-拉米夫定-奈韦拉平的一线抗逆转录病毒治疗。收集了患者的临床和实验室数据。结果通过卡方检验、t检验和威尔科克森秩和检验进行分析。11.5%的感染艾滋病毒患者的平均血压提示患有高血压,而未感染艾滋病毒的患者为10.6%(P=0.751)。但绝对值上,感染艾滋病毒患者的舒张压中位数为90mmHg,而未感染艾滋病毒的患者为85mmHg(P<0.001)。4.04%的感染艾滋病毒患者的体重指数提示肥胖,而未感染艾滋病毒的患者为6.08%(P=0.187)。对于空腹血糖:2.50%的感染艾滋病毒患者与4.20%的未感染艾滋病毒患者的血清空腹血糖提示患有糖尿病(P<0.176)。11.9%的感染艾滋病毒患者的总胆固醇大于200mg/dl,而未感染艾滋病毒的患者为7.4%(P=0.019)。对于高密度脂蛋白胆固醇:36.40%的感染艾滋病毒患者的血清空腹≤40mg/dl,而未感染艾滋病毒的患者为15.70%(P<0.001)。感染艾滋病毒患者的空腹总胆固醇中位数(140mg/dl)高于未感染艾滋病毒的患者(133mg/dl)[P=0.015]。未感染艾滋病毒的患者的空腹高密度脂蛋白胆固醇中位数(58.5mg/dl)高于感染艾滋病毒的患者(49mg/dl)[P<0.001]。感染艾滋病毒的女性更有可能总胆固醇平均值更高:感染艾滋病毒的男性为147.70±52.09mg/dl,而感染艾滋病毒的女性为135.72±48.23mg/dl(P=0.014),高密度脂蛋白胆固醇平均值也更高:感染艾滋病毒的男性为55.80±30.77mg/dl,而感染艾滋病毒的女性为48.24±28.57mg/dl(P=0.008)。在这个研究人群中,感染艾滋病毒的患者高血压患病率高于未感染艾滋病毒的患者。基于司他夫定-拉米夫定-奈韦拉平的一线抗逆转录病毒治疗呈艾滋病毒阳性与总胆固醇>200mg/dl和高密度脂蛋白胆固醇≤40mg/dl的高患病率相关。对该人群进行血脂异常和高血压的主动筛查和及时管理应成为优先事项。