Cardiovascular Journal of Africa: Vol 26 No 2 (March/April 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015 52 AFRICA
Cardiovascular Topics
Association of Helicobacter pylori infection with the
metabolic syndrome among HIV-infected black Africans
receiving highly active antiretroviral therapy
Benjamin Longo-Mbenza, Teke Apalata, Murielle Longokolo, Marcel Mbula Mambimbi, Etienne
Mokondjimobe, Thierry Gombet, Bertrain Ellenga, Baudouin Buassa-bu-Tsumbu, Guy Milongo Dipa,
Evelyne Lukoki Luila, Augustin Nge Okwe
Abstract
Introduction: The metabolic syndrome (MetS) is common
in human immune deficiency virus (HIV)-infected individu-
als receiving highly active antiretroviral therapy (HAART).
Immune deficiencies caused by HIV give rise to numerous
opportunistic gastrointestinal pathogens such as Helicobacter
pylori, the commonest cause of chronic gastritis. The study
sought to determine the relationship between H pylori infec-
tion and the MetS among HIV-infected clinic attendees.
Methods: This cross-sectional study was carried out in a
specialised heart clinic in Kinshasa, DR Congo. Between
January 2004 and December 2008, 116 HIV-infected patients
(61 with MetS and 55 without MetS) who underwent
upper gastrointestinal endoscopy for dyspeptic symptoms
were included in the study following an informed consent.
Univariate associations were determined by odds ratios (OR),
while multivariate logistic regression analysis was used to
identify factors associated with the MetS.
Results: H pylori infection (OR = 13.5, 95% CI: 10.3–17.6;
p < 0.0001) and peripheral obesity (median hip circumfer-
ence ≥ 97 cm) (OR = 4.7, 95% CI: 1.2–18.8; p = 0.029) were
identified as MetS-related factors in HIV-infected patients.
Higher rates of the MetS were associated with increased inci-
dence of HIV-related immunocompromise using World Health
Organisation (WHO) staging criteria. There was a univariate
significant difference in the prevalence of the MetS between
antiretroviral therapy (ART)-naïve patients and patients treat-
ed by means of a first-line HAART regimen of stavudine
(d4T), lamivudine (3TC) and nevirapine (NVP). However, this
difference was not significant in multivariate logistic analysis.
Conclusion: H pylori infection was significantly associated
with the MetS in HIV-infected patients.
Keywords: metabolic syndrome, Helicobacter pylori, HIV,
HAART
Submitted 13/2/13, accepted 27/1/15
Cardiovasc J Afr 2015; 26: 52–56
DOI: 10.5830/CVJA-2015-012
Developing countries have recently been experiencing an increase
in the prevalence of risk factors associated with the metabolic
syndrome (MetS) and cardiovascular diseases (CVD) in both
general and working class populations.1-5 Progressive urbanisation
and westernisation of lifestyle leading to an epidemiological
transition in developing countries can be mentioned among
possible reasons. 1,2
The metabolic syndrome is a cluster of metabolic and
haemodynamic risk factors that act multiplicatively to promote
atherosclerotic CVD and type 2 diabetes mellitus (T2DM).6,7
Its initial description by Reaven (1988) included dyslipidaemia,
hypertension, hyperglycaemia and insulin resistance.8 These
disturbances promote an elevated prothrombotic/procoagulant
state, endothelial cell dysfunction and inflammatory response
with premature atherosclerotic complications.9,10
Helicobacter pylori, a spiral-shaped gram-negative flagellated
bacterium, enhances human chronic inflammatory diseases. 11
Research Unit, Faculty of Health Sciences, Walter Sisulu
University, Mthatha, South Africa
Benjamin Longo-Mbenza, MD
Department of Medical Microbiology, Faculty of Health
Sciences, Walter Sisulu University, Mthatha, South Africa
Teke Apalata, MD,
Department of Internal Medicine, University of Kinshasa,
Democratic Republic of the Congo
Murielle Longokolo, MD
Marcel Mbula Mambimbi, MD
Laboratoire de Biochimie et Pharmacologie, Faculté des
Sciences de Santé, Brazzaville, Congo
Etienne Mokondjimobe, MD
Baudouin Buassa-bu-Tsumbu, MD
Centre Hospitalier Universitaire, Faculté des Sciences de
Santé, University of Marien Ngouabi, Brazzaville, Congo
Thierry Gombet, MD
Bertrain Ellenga, MD
Biostatistic Unit, Lomo Medical Cardiovascular Centre for
Africa, Limete, Kinshasa, Democratic Republic of the Congo
Guy Milongo Dipa, MD
Evelyne Lukoki Luila, MD
Augustin Nge Okwe, MD