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      Étude interventionnelle sur le dolutégravir et les autres antirétroviraux dans l’athérosclérosclérose infra-clinique en milieu hospitalier de Kinshasa Translated title: Interventional study on Dolutegravir and other antiretrovirals in patients with subclinical atherosclerosis in the Kinshasa Hospital

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      1 , 1 , 1 , 1 , 2 , 1 , 1 , 1 , 3 , 3 , 4 , 4 , 4 , 5 , 1 , 6 , 6 , 7 , 8 , & ,
      The Pan African Medical Journal
      The African Field Epidemiology Network
      Athérosclérose infraclinique, VIH/SIDA, thérapie antirétrovirale, Kinshasa, République Démocratique du Congo, Subclinical atherosclerosis, HIV/AIDS, antiretroviral therapy, Kinshasa, Democratic Republic of Congo

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          Abstract

          Introduction

          après 2016, l´Organisation mondiale de la Santé (OMS) a proposé le dolutégravir (DTG) comme alternative thérapeutique de traitement de première ligne chez l´adulte. Ainsi, l´objectif de la présente étude était d´identifier les biomarqueurs du risque cardiométabolique capable de démontrer l´effet bénéfique du dolutégravir (DTG) par rapport aux autres antirétroviraux dans la prédiction de l´athérosclérose chez les personnes vivant avec le VIH (PVVIH) en milieu hospitalier de Kinshasa.

          Méthodes

          il s´agissait d´une étude interventionnelle entre janvier 2017 et décembre 2021 chez les PVVIH sous traitement antiretroviral (TAR) durant au moins 6 mois, pris en charge dans les structures du Réseau Catholique du Bureau Diocésain des Oeuvres Médicales (BDOM) et aux Cliniques Universitaires de Kinshasa (CUK). L´athérosclérose infraclinique était définie par: une pression pulsée (PP) ≥60 mm Hg; une épaisseur intima-media carotidien (EIMc)> 0,8 mm et un Index des pressions systoliques (IPS) <0,9. La régression logistique a été utilisée dans l'étude statistique des associations.

          Résultats

          au total, 334 PVVIH ont été recrutées dont 96,1% (n=321) sous TAR et 13,9% (n=13) naïfs de TAR. L´âge moyen des PVVIH était de 51±12 ans avec une prédominance féminine 70,4% (n=235); Les déterminants indépendants de l´athérosclérose infraclinique étaient les mariés (ORa: 4, IC95% 1,5-10,5; p<0,006), le niveau socioéconomique bas (ORa: 10,7, IC95% 2,3-48,7 p<0,002), la durée de l´infection par le VIH (ORa: 6,6, IC95% 2,8-16; p<0,0001), la durée du traitement antirétroviral ≥9 années (ORa: 0,3, IC 95% 0,2-0,7; p< 0,005) et le ratio cholestérol total/high density lipoprotein-cholesterol (CT/HDL-c)(ORa: 2, IC 95% 1,1-3,6; p=0,034). Les valeurs moyennes des variables traditionnelles et émergentes étaient significativement supérieures dans l´ancien régime TAR sans DTG que dans le nouveau régime avec DTG. Par contre la dyslipidémie a été identifiée du côté du nouveau régime avec DTG.

          Conclusion

          la dyslipidémie a été fréquente du côté de DTG. Les mariés, le niveau socioéconomique bas, la durée de l´infection par le VIH, la durée du traitement antirétroviral au-delà de 9 années et le ratio CT/HDL-c ont été identifiés comme déterminants de l´athérosclérose infraclinique chez les PVVIH sous TAR en milieu hospitalier de Kinshasa.

          Translated abstract

          Introduction

          After 2016, the World Health Organization (WHO) proposed Dolutegravir (DTG) as an alternative first-line treatment for adults. Thus, the purpose of this study was to identify biomarkers of cardiometabolic risk capable of demonstrating the beneficial effect of Dolutegravir (DTG) compared to other antiretrovirals in predicting atherosclerosis in people living with HIV (PLHIV) and hospitalized in Kinshasa Hospital.

          Methods

          we conducted an interventional study of people living with HIV who had received antiretroviral therapy (ART) for at least 6 months and were treated in the structures of the network coordinated by the Catholic Church (BDOM-Bureau Diocésain des Oeuvres Médicales) and of the University Clinics of Kinshasa (CUK) between January 2017 and December 2021. Subclinical atherosclerosis was defined as Pulsed Pressure (PP) ≥60 mm Hg; Carotid Intima-Media Thickness (CIMT) > 0.8 mm; and Systolic Pressure Index (SPI) < 0.9. Logistic regression was used in the statistical analysis of associations.

          Results

          a total of 334 PLHIV were recruited, of whom 96.1% (n=321) were on ART and 13.9% (n=13) were ART naïve patients. The mean age of PLHIV was 51±12 years with a female predominance (70.4%; n=235); the independent determinants of subclinical atherosclerosis were marital status (aOR: 4. 95% CI 1.5-10.5; p<0.006), low socioeconomic level (aOR: 10.7, 95% CI 2.3-48.7 p<0.002), duration of HIV infection (aOR: 6.6, 95% CI 2.8-16; p<0.0001), duration of antiretroviral therapy ≥9 years (aOR: 0.3, 95% CI 0.2-0.7; p<0.005) and total cholesterol ratio/high-density lipoprotein-cholesterol (CT/HDL-c)(aOR: 2, 95% CI 1.1-3.6; p= 0.034). The mean values of traditional and emergent variables were significantly higher in the previous ART regimen without DTG than in the new regimen with DTG. However, dyslipidemia was detected during the new DTG-based regimen.

          Conclusion

          dyslipidemia was common during the DTG-based regimen. Marital status, low socioeconomic level, duration of HIV infection, duration of antiretroviral treatment beyond 9 years and the TC/HDL-c ratio were identified as determinants of subclinical atherosclerosis in PLHIV on ART hospitalized in the Kinshasa hospital.

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          Most cited references41

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

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            Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.

            A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
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              Combination antiretroviral therapy and the risk of myocardial infarction.

              It remains controversial whether exposure to combination antiretroviral treatment increases the risk of myocardial infarction. In this prospective observational study, we enrolled 23,468 patients from 11 previously established cohorts from December 1999 to April 2001 and collected follow-up data until February 2002. Data were collected on infection with the human immunodeficiency virus and on risk factors for and the incidence of myocardial infarction. Relative rates were calculated with Poisson regression models. Combination antiretroviral therapy was defined as any combination regimen of antiretroviral drugs that included a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor. Over a period of 36,199 person-years, 126 patients had a myocardial infarction. The incidence of myocardial infarction increased with longer exposure to combination antiretroviral therapy (adjusted relative rate per year of exposure, 1.26 [95 percent confidence interval, 1.12 to 1.41]; P<0.001). Other factors significantly associated with myocardial infarction were older age, current or former smoking, previous cardiovascular disease, and male sex, but not a family history of coronary heart disease. A higher total serum cholesterol level, a higher triglyceride level, and the presence of diabetes were also associated with an increased incidence of myocardial infarction. Combination antiretroviral therapy was independently associated with a 26 percent relative increase in the rate of myocardial infarction per year of exposure during the first four to six years of use. However, the absolute risk of myocardial infarction was low and must be balanced against the marked benefits from antiretroviral treatment. Copyright 2003 Massachusetts Medical Society
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                Author and article information

                Contributors
                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                26 May 2023
                2023
                : 45
                : 63
                Affiliations
                [1 ]Service des Maladies infectieuses, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo,
                [2 ]Service de Néphrologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo,
                [3 ]Département de Radiologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo,
                [4 ]Service de Biologie Clinique, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo,
                [5 ]École de Santé Publique, Université de Kinshasa, République Démocratique du Congo,
                [6 ]Department of Public Health, Lomo University of Research, Kinshasa, Democratic Republic of Congo,
                [7 ]Service de Cardiologie, Cliniques Universitaires de Kinshasa, Kinshasa, République Démocratique du Congo,
                [8 ]Walter Sisulu University, Department of Health, Mthatha, South Africa
                Author notes
                [& ] Corresponding author: Benjamin Longo-Mbenza, Department of Public Health, Lomo University of Research, Kinshasa, Democratic Republic of Congo. longombenza@ 123456gmail.com
                Article
                PAMJ-45-63
                10.11604/pamj.2023.45.63.39461
                10460102
                341e1117-2d1a-4781-8b5a-2db7603e120b
                Copyright: Murielle Longokolo Mashi et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 February 2023
                : 02 May 2023
                Categories
                Research

                Medicine
                athérosclérose infraclinique,vih/sida,thérapie antirétrovirale,kinshasa,république démocratique du congo,subclinical atherosclerosis,hiv/aids,antiretroviral therapy,democratic republic of congo

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