Facteurs de risque cardiovasculaire chez les patients avant et après initiation des antirétroviraux en Afrique Sub-Saharienne, expérience de l’Essai Temprano ANRS 12 136

The international initiatives for promoting access to antiretroviral therapy (ART) have reduced HIV- related morbidity and mortality. Meanwhile, there are growing cardiovascular risk factors (CVRF) in developing countries, which are witnessing an epidemiological transition. Our objective was to assess the significance of CVRF before and after initiating antiretroviral therapy in HIV-infected people in Africa. Temprano trial aimed to assess the benefits and risks of early antiretroviral therapy and 6-month isoniazid preventive therapy (IPT) after 30-month follow-up. This study concluded that both interventions are effective to reduce severe morbidity, what led WHO, in 2015, to recommend starting ART immediately if CD4 count drop below 500 cells / mm3. In this study, we assessed the prevalence of CVRF and the significance of obesity and overweight at baseline and after 24 months of ART in particular. We then assess the cardiovascular risk score according to the Framingham equation, with and without lipids, at baseline and at the end of follow-up. There were: (i) a positive correlation between the 2 equations (ii) a sharper increase in cardiovascular risks among women and (iii) no difference in the risk increase according to treatment strategies. Finally, in the long-term follow-up of Temprano trial, we are showing the efficacy of IPT on the reduction of mortality, which brings hope in a context where, despite the on-going epidemiological transition, the causes of deaths are still dominated by Tuberculosis in sub- Saharan Africa.Les initiatives internationales pour l’accès au traitement antirétroviral (ARV) ont permis une réduction de la morbi-mortalité liée au VIH. Parallèlement, il existe croissance des risques cardio vasculaire (FRCV) dans les pays en développement, témoin d’une transition épidémiologique. Notre objectif était d’évaluer l’importance des FRCV avant et après mise sous antirétroviraux chez des personnes infectées par le VIH en Afrique. L’essai Temprano avait pour objectif d’évaluer les bénéfices et risque du traitement antirétroviral précoce et d’une chimio prophylaxie par 6 mois d’isoniazide (IPT) après 30 mois de suivi. Cette étude a conclu à l’efficacité des 2 interventions sur la réduction de la morbidité sévère, conduisant l’OMS, dès 2015, à recommander les ARV dès que les CD4 sont inférieurs à 500 CD4/mm3. Dans ce travail, nous avons évalué la prévalence des FRCV, et en particulier l’importance de l’obésité et du surpoids, à l’inclusion puis après 24 mois d’ARV. Nous avons ensuite calculé le score de risque cardio vasculaire selon l’équation de Framingham, avec et sans lipides à l’inclusion et à la fin du suivi. Il existait(i) une bonne corrélation des 2 équations (ii) une augmentation plus marquée du risque cardiovasculaire chez les femmes et (iii) une absence de différence de l’augmentation du risque selon les stratégies thérapeutiques. Enfin, dans le suivi long terme de Temprano nous montrons une efficacité de l’IPT sur la réduction de la mortalité, ce qui apporte un espoir dans un contexte où, malgré la transition épidémiologique en cours, les causes de mortalité sont toujours dominées par la Tuberculose en Afrique sub-saharienne

High prevalence of being Overweight and Obese HIV-infected persons, before and after 24 months on early ART in the ANRS 12136 Temprano Trial

International audienceAbstractBackgroundHIV is usually associated with weight loss. World health Organization (WHO) recommends early antiretroviral (ART) initiation, but data on the progression of body mass index (BMI) in participants initiating early ART in Africa are scarce.MethodsThe Temprano randomized trial was conducted in Abidjan to assess the effectiveness of early ART and Isoniazid (INH) prophylaxis for tuberculosis in HIV-infected persons with high CD4 counts below 800 cells/mm3 without any indication for starting ART. Patients initiating early ART before December 2010 were included in this sub-study. BMI was categorized as: underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). At baseline and after 24 months of ART, prevalence of being overweight or obese and factors associated with being overweight or obese were estimated using univariate and multivariate logistic regression.ResultsAt baseline, 755 participants (78 % women; median CD4 count 442/mm3, median baseline BMI 22 kg/m2) initiated ART. Among them, 19.7 % were overweight, and 7.2 % were obese at baseline. Factors associated with being overweight or obese were: female sex aOR 2.3 (95 % CI 1.4–3.7), age, aOR for 5 years 1.01 (95 % CI 1.0–1.2), high living conditions aOR 2.6 (95 % CI 1.5–4.4), High blood pressure aOR 4.3 (95 % CI 2.0–9.2), WHO stage 2vs1 aOR 0.7 (95 % CI 0.4–1.0) and Hemoglobin ≥95 g/dl aOR 3.0 (95 % CI 1.6–5.8). Among the 597 patients who attended the M24 visit, being overweight or obese increased from 20.4 to 24.8 % (p = 0.01) and 7.2 to 9.2 % (p = 0.03) respectively and factor associated with being overweight or obese was immunological response measured as an increase of CD4 cell count between M0–M24 (for +50 cells/mm3: aOR 1.01; 95 % CI 1.05–1.13, p = 0.01).ConclusionThe weight categories overweight and obese are highly prevalent in HIV-infected persons with high CD4 cell counts at baseline, and increased over 24 months on ART in this Sub-Saharan African population

Tobacco use and its determinants in HIV-infected patients on antiretroviral therapy in West African countries.: Tobacco use in HIV-infected patients in West Africa

International audienceBACKGROUND: Tobacco smoking is common in human immunodeficiency virus (HIV) infected patients from industrialised countries. In West Africa, few data concerning tobacco consumption exist. METHODS: A cross-sectional survey of the International Epidemiological Database to Evaluate AIDS (IeDEA) network in West Africa was conducted. Health workers administered a questionnaire assessing tobacco and cannabis consumption among patients receiving antiretroviral treatment. Regular smokers were defined as current smokers who smoked >1 cigarette per day for >or=1 year. RESULTS: Overall, 2920 patients were enrolled in three countries. The prevalence of ever smokers and regular smokers were respectively 46.2% (95%CI 42.8-49.5) and 15.6% (95%CI 13.2-18.0) in men and 3.7% (95%CI 2.9-4.5) and 0.6% (95%CI 0.3-0.9) in women. Regular smoking was associated with being from Côte d'Ivoire or Mali compared to Benin (OR 4.6, 95%CI 2.9-7.3 and 7.7, 95%CI 4.4-13.6), severely impaired immunological status at highly active antiretroviral treatment initiation (OR 1.5, 95%CI 1.1-2.2) and history of tuberculosis (TB; OR 1.8, 95%CI 1.1-3.0). CONCLUSION: There are marked differences in smoking prevalence among these West African countries. This survey approach also provides proof of the association between cigarette smoking and TB in HIV-infected patients, a major public health issue in this part of the world

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population