[Interventional study on Dolutegravir and other antiretrovirals in patients with subclinical atherosclerosis in the Kinshasa Hospital]. / Étude interventionnelle sur le dolutégravir et les autres antirétroviraux dans l'athérosclérosclérose infra-clinique en milieu hospitalier de Kinshasa.

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.

Morphometric semi-quantitative assessment of vertebral fractures in postmenopausal black women in Central Africa.

This prospective and multi-centric study assessed the lacking of pattern in fractured patients and features of vertebral fractures in postmenopausal black women living in central Africa. INTRODUCTION: Patients with osteoporosis commonly collapsed their vertebral body. This has been widely studied in Caucasians, Asians, and Americans and studies in black African are lacking. Our study was designed to establish a pattern of patients with fractures and determine the features of vertebral fractures in postmenopausal black women living in Central Africa. METHODS: A prospective and multi-centric study was conducted from June 2011 to June 2016, to assess the thoraco-lumbar-computed tomographic images of women. The menopausal statuses and anthropometric parameters (age, height, and weight) were collected. The body mass index and the Asset Poverty Index were evaluated. The reviews included a morphometric analysis of each vertebra that was rated according to the visual semi-quantitative system proposed by Genant et al. RESULTS: Four hundred thirty women aged 47-87 years old were included in this study. The mean age was 57 years old, and the mean menopause duration was 11.45 ± 6.6 years with extremes ranging from 2 to 37 years. The body mass indices were rated as overweight and obese in 80.8% of subjects and 54, 3% had high-API indices. Among the 4730 vertebrae analyzed, 529 (11.12%) were fractured, with 68.7% exhibited a cup-shaped deformation (biconcave), 19.8% had a wedge-shaped deformation, and 11.4% exhibited a cake (crush) deformation. Of the vertebras, 88.8% were grade 0, 5.5% grade 1, 5% grade 2, and 0.57% were grade 3. Of the women, 68.8% had one vertebra fractured and 31.2% had more than one fractured vertebrae. CONCLUSION: This study seemed to determine the pattern and features of vertebral fractures in black African women which may be useful for comparisons with the pattern of worldwide populations.