Prevalence and Cardiovascular Risk Factors Associated with Obesity/ Overweight in Adult Patients Living with HIV/AIDS: Case of the Makokou Outpatient Treatment Center, Ogooué-Ivindo, North-Eastern Gabon
Armel Obiandong Eyivono
Medical Analysis Laboratory of the Centre Hospitalier Régional Omar Bongo Ondimba (CHROBO) Makokou, Gabon and Outpatient Treatment Centre, Makokou, Gabon.
Thiéry Ndong Mba *
Laboratory of Molecular and Cellular Biology (LABMC), Masuku University of Science and Technology (USTM), Franceville, Gabon and Biochemistry Research Laboratory (LAREBIO), Masuku University of Science and Technology (USTM), Franceville, Gabon.
*Author to whom correspondence should be addressed.
Abstract
Background: Designed to fight HIV/AIDS, antiretroviral drugs (ARVs) may be responsible for certain cardiometabolic abnormalities in people living with HIV (PLWHIV). To this end, the present study evaluates the prevalence and impact of obesity/overweight on the development of cardiovascular risk factors in patients at the outpatient treatment center (CTA) of Makokou, in the Ogooué-Ivindo region, North-eastern Gabon.
Materials and Methods: This is a cross-sectional and descriptive study, based on a retrospective analysis of the records of patients followed at the HIV/AIDS outpatient treatment center of Makokou from December 2015 to December 2020. A structured questionnaire was used to collect data such as age, gender, socio-economic level, daily habits such as alcohol consumption, tobacco consumption, and physical exercise. Other epidemiological parameters such as body mass index (BMI), and CD4 count were measured.
Results: A total of 165 people living with HIV (PLHIV), the majority of whom were between 41 and 60 years of age (60.60%). treated with antiretrovirals from December 2016 to December 2021 were collected for this study. With a sex ratio (F/M) of 3.58, women (78.2%) were in the majority compared to men. The mean age was 51 ± 13 years. While 95.8% of the patients were from the different departments of the province of Ogooué-Ivindo, the remaining patients (4.8%) were from other provinces such as Estuaire, Haut-Ogooué or Ogooué-Lolo. Civil servants represented 21%. The self-employed represented 29%, and the unemployed represented 50%. Only 34% of the participants in the study, the majority of whom were women, engaged in regular physical activity. 5.4% of the patients, mostly men, were active smokers. 34%, especially women, consumed alcohol. 20% of the PLWHIV had a medical history of type 2 diabetes mellitus or hypertension (HTA), and the majority were female. 5.4% of the declared hypertensives were on treatment. 7.8% of the hypertensive patients were discovered in consultation. The remainder were normotensive (86.8%). A significant difference in hypertension was observed in patients aged between 41 and 60 years ( p= 0.0029*). The data revealed a positive correlation index (r=0.19) between BMI and hypertension. All the therapeutic combinations with which the patients were treated contained NRTIs, of which the most used were tenofovir disoproxil (TDF) 66.67% and lamivudine (3TC) 33.33% and finally the most used NRTI was Efavirenz (EFV) 76.36%. After 5 years of treatment, 89 PLWHIV ( 53.93%), had CD4 count ≥ 500 cells/mm3. 53 PLWHIV (32%) had CD4 count ranging from 200 - 499 mm3 and thus moderate immune deficiency and with CD4 count < 200 cell /mm3, 23 PLWHIV (14%) had severe immune deficiency. HIV-infected patients under 40 years of age had a mean CD4 count of 412 cell/mm3, which was lower than that of patients 40 years of age and older, which was 556 cell/mm3. It was noted that after 5 years, treatment with ARVs was significantly associated with an increase in BMI among PLHIV, (P=0.0210). It was indicated that the increase or decrease of CD4 count in PLWHIV, depended on BMI, after 5 years of ARV treatment.
Conclusion: This study confirms the existence of an increase in overweight and obesity in people living with HIV/AIDS under antiretroviral treatment. It also shows that obesity had an impact on the development of certain cardiovascular risk factors in these people, which require careful vigilance of the health personnel on their weight gain, due to lipidic parameters such as cholesterol, HDL, Triglycerides.
Keywords: Prevalence, cardiovascular, obesity/overweight, HIV/AIDS, Makokou, Gabon
How to Cite
Downloads
References
Leclercq P, Grenoble C. HIV infection: a chronic inflammatory disease. Med Mal Infect, 2010;40:1-6.
Collaboration ATC. Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries. International Journal of Epidemiology. 2009;38(6):1624-1633.
Lewden, C., et al., HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2007;46(1): 72-77.
Braithwaite, R.S., et al., Estimating the proportion of patients infected with HIV who will die of comorbid diseases. The American Journal of Medicine. 2005; 118(8):890-898.
Lewden, C., et al., Causes of death of HIV-infected people in 2000: persistence of AIDS, emerging role of cancers and hepatitis. Bull Epidemiol; 2004.
Leclercq P, Roudiere L, Viard JP. Serious complications of antiretroviral treatments. Reanimation. 2004;13(3):238-248.
Peroz-Froz J, et al., Cardiovascular complications of antiretroviral therapies. Metabolic Disease Medicine. 2012; 6(1):25-30.
Friis-Møller N et al., Cardiovascular disease risk factors in HIV patients–association with antiretroviral therapy. Results from the DAD study. Aids. 2003; 17(8):1179-1193.
Obry-Roguet, V., et al., Overweight, obesity and HIV infection: prevalence and analysis of associated factors. Medicine and Infectious Diseases, 2017.47(4): S139.
Chanu, B. and P. Valensi, Lipid disorders in patients with HIV-induced conditions. The Medical Press. 2005;34(15):1087-1094.
Okome Nkoumou MML, Okome Essima R, Obiang Ndong GP, Okome Miame F. Clinical and biological assessment of patients infected with HIV at the Jeanne Ebori Foundation in Libreville (2002-2005) Med Trop. 2007;67:357–362. [Google Scholar]
UNIES, N. and C.E.E. SOCIAL, The female dimension of HIV/AIDS in Africa. 2004. consulted on 1 November 2022
Djagadoi Kodjo Agbeko, Tchamdja Toyi, Djalogue Lihanimpo, Némi Komi Dzidzonu, Kaaga Laconi, Balaka Abago, Djibril Mohamna Awalou. Lipid and carbohydrate disorders at cardiovascular risk in people living with the human immunodeficiency virus, under antiretroviral treatment: Case of the medical care center of the NGO Vie-Togo, in Lomé
Mukeba-Tshialala D et al. Untreated obesity, hypertension, hypercholester-olemia and diabetes among HIV-infected and non-HIV-infected adults in Mbuji-Mayi (Democratic Republic of the Congo). Bulletin of the Exotic Pathology Society. 2017;110(5):301-309.
Lachaud JP. HIV prevalence and poverty in Africa: Micro and macro-econometric evidence applied to Burkina Faso. Working Paper. 2005;(112).
Giraud H. Cardiovascular risk factors in patients living with HIV, inventory and Prospects for Management in General Practice; 2015.
Djalloh AMA et al., Prevalence and determinants of atherosclerosis in patients infected with the human immunodeficiency virus (HIV) and treated with anti-retrovirals. JMV-Journal of Vascular Medicine. 2018. 43(2): 115.
Canadian Source for HIV and Hepatitis C Information; Pulmonary hypertension and HIV.
Pugliese P. et al., K-01 Clinical, biological and therapeutic characteristics of 10,458 HIV patients followed in the NADIS cohort on 09/30/2007. Medicine and Infectious Diseases. 2008;38: S161.
Viard JP. et al., Influence of age on CD4 cell recovery in human immunodeficiency virus–infected patients receiving highly active antiretroviral therapy: evidence from the EuroSIDA study. The Journal of Infectious Diseases. 2001;183(8): 1290-1294.
Letembet V. Long-term weight change in PLHIV. Medicine and Infectious Diseases. 2020;50(6):S189-S190.
Hurley E et al., Weight evolution and perceptions of adults living with HIV following initiation of antiretroviral therapy in a South African urban setting. South African Medical Journal. 2011;101(9): 645-650.
Aissat FZ, Amrane A, Service B, EHS El Kettar, Algiers Lipid profile in PLHIV under antiretroviral treatment National Congress of Infectious Pathology Tunisia ; 2021.
Crum-Cianflone NF et al., Obesity among HIV-infected persons: impact of weight on CD4 cell count. AIDS (London, England). 2010;24(7):1069.
Womack J et al., Obesity and immune cell counts in women. Metabolism. 2007;56(7): 998-1004.