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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015
54
AFRICA
H pylori
infection was assayed by the determination of
immunoglobulin G (IgG) antibodies as described elsewhere.
4
Briefly, IgG antibodies to
H pylori
(anti-HP Ab) were measured
by a commercial enzyme-linked immunosorbent assay (Pyloriset
®
EIA-G; Orion Diagnostica, Espoo, Finland). The detection range
of serum levels of anti-HP Ab assay was between 100 and 12 800 U.
Imaging techniques
Subclinical atherosclerosis was assayed by IMT using echo-
Doppler, and the diagnosis of
H pylori
-related chronic gastritis
was confirmed as described elsewhere.
4
Atherosclerotic
complications including different forms of CVD (myocardial
infarction, stroke, peripheral artery disease) were ascertained
by clinical symptoms and signs, cardiac enzymes and tropinin
levels, as well as results from electrocardiogram, echo-Doppler,
tomodensitometry and coronary angiogram.
Statistical analyses
Data were expressed as means
±
standard deviation (SD) for
the continuous variables and proportions (percentages) for the
categorical variables. The Student’s
t
-test was performed to
assess differences between two means and ANOVA between
groups. When data were not normally distributed, the Mann–
Whitney
U
-test was used. Either the chi-square test with and
without trend or Fischer’s exact test was used to test the degree
of association of categorical variables.
Variables were first computed to identify univariate potential
factors and cardiometabolic co-morbidities associated with
the MetS; the significant association between variables being
calculated as odds ratios (OR) with 95% confidence interval
(CI). Potential factors demonstrating a univariate relationship (
p
<
0.20) with the MetS were included in the multivariate logistic
regression analysis to assess the effect of their independent
association with the MetS. Goodness-of-fit was verified with
the Hosmer and Lemeshow statistical method. A
p
-value
<
0.05
was considered statistically significant. All data were analysed
using the Statistical Package for the Social Sciences (SPSS for
Windows, version 21; Chicago, IL).
Results
A total of 116 heterosexual HIV-infected patients were enrolled.
Of the 116 eligible study participants, 54 (46.6%) were men and
62 (53.4%) women. The mean age of the study participants
was 42
±
9 years. Of these, 65 (56%) were ART naïve and 51
(44%) were on a 13
±
1 month first-line HAART regimen of
stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). No
patient received either efavirenz or protease inhibitors. Based on
the 2005 International Diabetes Federation definition, 61/116
patients (52.6%) met the criteria for the MetS versus 55/116
patients (47.4%) without the MetS.
During univariate analyses, numerous factors were shown
to be significantly associated with the MetS in HIV-infected
individuals, as depicted in Tables 1 and 2. There was a significant
univariate association in the prevalence of the MetS between
ART-naïve patients and those treated by means of a first-line
HAART regimen of d4T, 3TC and NVP (Table 1) but this
association did not reach significant difference in multivariate
regression analysis.
Table 1. Univariate factors associated with the metabolic
syndrome in HIV-infected individuals (
n
= 116)
Variable of interest
Presence
of MetS
n
(%)
Absence
of MetS
n
(%)
OR
(95% CI)
p
-value
Gender
1.4 (0.7 – 3)
0.332
males (
n
=
54)
31 (57.4) 23 (42.6)
females (
n
=
62)
30 (48.4) 32 (51.6)
Socio-economic status (SES)
3.3 (1.4 – 7.8)
0.004
high (
n
=
36)
26 (72.2) 10 (27.8)
low (
n
=
80)
35 (43.8) 45 (56.2)
Smoking
10.5 (2.9 – 37.9)
<0.0001
yes (
n
=
26)
23 (88.5) 3 (11.5)
no (
n
=
90)
38 (42.2) 52 (57.8)
Helicobacter pylori
sero-
positivity
95.3 (20.4 – 444.7) <0.0001
yes (
n
=
72)
59 (81.9) 13 (18.1)
no (
n
=
44)
2 (4.5) 42 (95.5)
chronic gastritis due to
H pylori
28.1 (9.5 – 83)
<0.0001
yes (
n
=
50)
45 (90)
5 (10)
no (
n
=
66)
16 (24.2) 50 (75.8)
Peripheral obesity (median
hip circumference ≥ 97 cm)
4.6 (2.1 – 10)
<0.0001
yes (
n
=
58)
41 (70.7) 17 (29.3)
no (
n
=
58)
20 (32.8) 38 (67.2)
Excessive alcohol intake
3.3 (1.5 – 7.4)
0.003
yes (
n
=
44)
31 (70.5) 13 (29.5)
no (
n
=
72)
30 (41.7) 42 (58.3)
HAART exposure
2.4 (1.01 – 5.7)
0.045
yes (
n
=
65)
34 (52.3) 31 (47.7)
no (
n
=
35)
11 (31.4) 24 (68.6)
HAART = highly active antiretroviral therapy; MetS = metabolic syndrome;
OR = odds ratio; CI = confidence interval.
Table 2. Other univariate factors associated with metabolic
syndrome in HIV-infected individuals (
n
=
116)
Variables of interest
Presence of Mets
Mean ± SD
Absence of Mets
Mean ± SD
p
-value
ANOVA
Age (years)
46.4 ± 8
40.8 ± 11.1
0.005
BMI (kg/m²)
23.1 ± 4.4
20.5 ± 4.1
0.003
WC (cm)
109.2 ± 16.8
90 ± 16.6 < 0.0001
HC (cm)
111.6 ± 13.7
103.2 ± 16.3
0.013
SBP (mmHg)
138.7 ± 25.1
114.5 ± 21
< 0.0001
DBP (mmHg)
77.1 ± 12.9
72.3 ± 12.2
0.068
Pulse pressure (mmHg)
61.6 ± 23.2
42.2 ± 13.2 < 0.0001
Haemoglobin (g/dl)
13.7 ± 1.1
12.2 ± 1.8
0.005
Haematocrit (%)
36.8 ± 5.9
28.2 ± 7.4
< 0.0001
IgG
H pylori
(U/ml)
394.6 ± 61.1
126.9 ± 192.1 < 0.0001
CD4
+
count (cells/mm
3
)
199.5 ± 157.9
181.5 ± 193.9
0.026**
Viral load (copies/ml)
270373 ± 147064 208741 ± 102629 < 0.0001**
Uric acid (mg/dl)
33.9 ± 10.2
10.7 ± 10.8 < 0.0001
Fasting glucose (mg/dl)
130.1 ± 26.4
106.4 ± 50.2
0.008
(mmol/l)
7.22 ± 1.47
5.91 ± 2.79
Total cholesterol (mg/dl)
193.9 ± 51.9
157.6 ± 79.8
0.018
(mmol/l)
5.02 ± 1.34
4.08 ± 2.07
HDL-C (mg/dl)
78.5 ± 26.6
70.4 ± 16.8
0.084
(mmol/l)
2.03 ± 0.69
1.82 ± 0.44
Triglycerides (mg/dl)
255.8 ± 41.7
206.8 ± 69.5
0.009
(mmol/l)
2.89 ± 0.47
2.34 ± 0.79
Oxidised LDL-C (mg/dl)
155.1 ± 0.3
101.2 ± 0.1
< 0.0001
(mmol/l)
4.02 ± 0.01
2.62 ± 0.00
**Non-parametric Mann–Whitney
U
-test