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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015
AFRICA
55
When using non-parametric Mann–Whitney
U
-tests, there
were significant univariate associations of CD4
+
T cell counts
and HIV viral loads with the MetS (Table 2). There was also
a significant relationship (
p
<
0.0001) between the WHO
HIV disease stages and the presence of the MetS (Fig. 1).
HIV-infected patients of WHO stages 3 and 4 were in CDC stage
C and those of WHO stages 1 and 2 were in CDC stage B.
However, during multivariate logistic regression analysis, after
adjusting for age, SES, HAART exposure, smoking, excessive
alcohol intake, waist circumference, CD4
+
T-cell counts and
plasma HIV loads,
H pylori
seropositivity (constant B
=
5.2; SE
=
1.114; wald
χ
2
=
21.785; OR
=
13.5, 95% CI: 10.3–17.6;
p
<
0.0001) and peripheral obesity (median hip circumference
≥
97
cm) (constant B
=
1.545; SE
=
0.708; wald
χ
2
=
4.756; OR
=
4.7,
95% CI: 1.2–18.8;
p
=
0.029) were identified as the only factors
significantly associated with the MetS in HIV-infected patients.
Discussion
The metabolic syndrome is recognised as a major public health
concern, even in the absence of HIV infection.
4,6,21,24
The majority
of patients with the MetS were defined by high SES, physical
inactivity, excessive alcohol intake, and total and peripheral
obesity.
6,25
In Africa, many individuals gain weight later in their
adult life and do not want to loose weight because of the stigma
of HIV.
24
Furthermore, abdominal obesity is considered a social
achievement.
Lifestyle has a strong influence on the MetS, particularly
among HIV-infected patients. Therefore the main emphasis in
the management of the MetS should focus on addressing lifestyle
changes, mainly efforts to stop smoking, reduce body weight and
alcohol intake, and increase moderate physical activity. Elevated
blood pressure, dyslipidaemia and hyperglycaemia may however
require additional drug treatment.
Additional correlates of the MetS among HIV-infected
Africans in our study population were hypercoagulability,
increased levels of uric acid, and infection/inflammatory
markers, as reported in other study cohorts of both HIV-infected
and uninfected patients.
4,5,26
Helicobacter pylori
infection and hip
circumference
≥
97cm (peripheral obesity) were identified as the
only factors associated with the MetS in our study population
during a multivariate analysis.
Findings from this study showed only univariate association
between exposure to first-line combination antiretroviral therapy
and the MetS. A previous report from the literature has
underlined the independent role of stavudine (d4T as a part of
ARV) in determining the MetS in HIV-infected populations.
26
A
possible contribution of the nucleoside analogue stavudine to
lipid abnormalities was also previously reported in the literature.
27
Numerous other studies confirmed that non-nucleoside reverse
transcriptase inhibitors had a more favourable impact on lipid
levels than most members of the protease inhibitor class.
24,28,29
In addition, higher frequency of coronary heart disease,
30
stroke
31
and diabetes mellitus
32
have been observed by others in
HIV/AIDS patients with the MetS. Oxidative stress-mediated
LDL cholesterol modification may be a key role player in
initiation and exacerbation of the MetS and atherosclerosis in
these HIV-infected patients.
Findings from this present study have supported
the association between
H pylori
infection and larger hip
circumference (
≥
97 cm). Appropriate lifestyle changes and in
some cases, medication (antibiotics, statins, antihypertensives,
antidiabetic drugs) may improve all of the MetS components.
Getting more physical activity, losing weight (5–10% of weight),
quitting smoking, limiting alcohol intake and appropriate diet
(vitamins, antioxidants, fruits, vegetables, fish and whole grains)
could be proposed to patients with the MetS.
Limitations of this study are mainly the small size of the
study sample, the cross-sectional study design, and absence of
an HIV-negative group. In this regard, results reported herein are
only associations from which no conclusions regarding causality
can be drawn.
Conclusion
H pylori
infection and peripheral obesity (median hip
circumference
≥
97 cm) were shown to be associated with higher
risk of the MetS in HIV/AIDS patients. Screening for the
presence of
H pylori
infection can be helpful when managing
HIV/AIDS patients diagnosed with the MetS. However, further
studies are warranted in order to ascertain the value of this
recommendation.
References
1.
World Health Organisation (WHO). Cardiovascular Disease Prevention
and Control, 2003. Accessed at http//www.who.int/cardiovascular-
disease.
2.
Longo-Mbenza B, Nkoy Belila J, Vangu Ngoma D, Mbungu S.
Prevalence and risk factors of arterial hypertension among urban
Africans in workplace: the obsolete role of body mass index.
Niger J
Med
2007;
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3.
Gombet T, Longo-Mbenza B, Ellenga-Mbolla B, Ikama MS, Kimbally-
Kaky G, Nkoua JL. Relationship between coronary heart disease,
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in Brazzaville.
Diab Metab Synd Clin Res Rev
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Longo-Mbenza B, Nkondi Nsenga J, Vangu Ngoma D. Prevention
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Int J Cardiol
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Diab Vasc Dis Res
2010;
7
(1):
Stage 1
(CD4
≥
500mm
3
)
Stage 2
(CD4
=
350–499mm
3
)
Stage 3
(CD4
=
200–349mm
3
)
Stage 4
(CD4
<
200mm
3
)
WHO staging
MetS (%)
33.30%
50%
78.90%
94.70%
Fig. 1.
Distribution of the MetS by HIV/AIDS WHO staging
groups (
p
<
0.0001).