Prevalence and Cardiovascular Risk Factors Associated with Obesity/ Overweight in Adult Patients Living with HIV/AIDS: Case of the Makokou Outpatient Treatment Center, Ogooué-Ivindo, North-Eastern Gabon

Background: Designed to fight HIV/AIDS, antiretroviral drugs (ARVs) may be responsible for certain cardiometabolic abnormalities in people living with HIV (PLWHIV). To this end, the present study evaluates the prevalence and impact of obesity/overweight on the development of cardiovascular risk factors in patients at the outpatient treatment center (CTA) of Makokou, in the Ogooué-Ivindo region, North-eastern Gabon.

Materials and Methods: This is a cross-sectional and descriptive study, based on a retrospective analysis of the records of patients followed at the HIV/AIDS outpatient treatment center of Makokou from December 2015 to December 2020. A structured questionnaire was used to collect data such as age, gender, socio-economic level, daily habits such as alcohol consumption, tobacco consumption, and physical exercise. Other epidemiological parameters such as body mass index (BMI), and CD4 count were measured.

Results: A total of 165 people living with HIV (PLHIV), the majority of whom were between 41 and 60 years of age (60.60%). treated with antiretrovirals from December 2016 to December 2021 were collected for this study. With a sex ratio (F/M) of 3.58, women (78.2%) were in the majority compared to men. The mean age was 51 ± 13 years. While 95.8% of the patients were from the different departments of the province of Ogooué-Ivindo, the remaining patients (4.8%) were from other provinces such as Estuaire, Haut-Ogooué or Ogooué-Lolo. Civil servants represented 21%. The self-employed represented 29%, and the unemployed represented 50%. Only 34% of the participants in the study, the majority of whom were women, engaged in regular physical activity. 5.4% of the patients, mostly men, were active smokers. 34%, especially women, consumed alcohol. 20% of the PLWHIV had a medical history of type 2 diabetes mellitus or hypertension (HTA), and the majority were female. 5.4% of the declared hypertensives were on treatment. 7.8% of the hypertensive patients were discovered in consultation. The remainder were normotensive (86.8%). A significant difference in hypertension was observed in patients aged between 41 and 60 years ( p= 0.0029*). The data revealed a positive correlation index (r=0.19) between BMI and hypertension. All the therapeutic combinations with which the patients were treated contained NRTIs, of which the most used were tenofovir disoproxil (TDF) 66.67% and lamivudine (3TC) 33.33% and finally the most used NRTI was Efavirenz (EFV) 76.36%. After 5 years of treatment, 89 PLWHIV ( 53.93%), had CD4 count ≥ 500 cells/mm3. 53 PLWHIV (32%) had CD4 count ranging from 200 - 499 mm3 and thus moderate immune deficiency and with CD4 count < 200 cell /mm3, 23 PLWHIV (14%) had severe immune deficiency. HIV-infected patients under 40 years of age had a mean CD4 count of 412 cell/mm3, which was lower than that of patients 40 years of age and older, which was 556 cell/mm3. It was noted that after 5 years, treatment with ARVs was significantly associated with an increase in BMI among PLHIV, (P=0.0210). It was indicated that the increase or decrease of CD4 count in PLWHIV, depended on BMI, after 5 years of ARV treatment.

Conclusion: This study confirms the existence of an increase in overweight and obesity in people living with HIV/AIDS under antiretroviral treatment. It also shows that obesity had an impact on the development of certain cardiovascular risk factors in these people, which require careful vigilance of the health personnel on their weight gain, due to lipidic parameters such as cholesterol, HDL, Triglycerides.