Les lipodystrophies secondaires aux traitements antirétroviraux de l’infection par le VIH

Prevalence and risk factors of peripheral artery disease in black Africans with HIV infection: a cross-sectional hospital-based study

Background

The prevalence of peripheral artery disease (PAD) is not well known among HIV-infected patients in Africa. The aim of this study was to determine the prevalence and associated risk factors of PAD among HIV-infected patients at the Douala General Hospital (DGH).

Methods

This was a cross-sectional descriptive and analytic study between November 2015 and April 2016. We recruited patients aged ≥21 years, diagnosed with HIV infection, and who were receiving care at the DGH. We collected sociodemographic data and past medical history of patients. We measured their ankle-brachial index (ABI). We defined PAD as an ABI <0.9. We also measured their fasting blood glucose and lipid profile.

Results

We recruited 144 patients for this study. The mean age was 46±9 years, and 72.2% were females. Of which, 89% were on antiretroviral treatment (ARV). Their mean CD4+ T lymphocytes count was 451±306 cells/mm³. Their mean ABI was 1.12±0.17 and 1.07±0.11, respectively, on the left and right legs (P>0.05). The prevalence of PAD was 6.9% (95% CI: 3.4–12.4), and 60% of patients with PAD were symptomatic. After adjusting for age, sex and ARV, ARV treatment was protective (aOR: 0.18, [95% CI: 0.04–0.82], P=0.034), while WHO stages III or IV was associated with PAD (aOR: 11.1, [95% CI: 2.19–55.92], P=0.004).

Conclusion

The prevalence of PAD was not as high as expected in this group of patients with high cardiovascular risk infected with HIV. Advanced HIV disease was associated with PAD, while ARV was protective.

High prevalence and impact on the quality of life of facial lipoatrophy and other abnormalities in fat tissue distribution in HIV-infected patients treated with antiretroviral therapy

Few data report the prevalence in actual clinical settings of lipodystrophy (LD), and in particular of facial lipoatrophy (LA), in HIV-infected patients treated with long-term antiretroviral therapy (ART). A French, multicenter, cross-sectional, observational study was conducted in HIV-infected patients on continuous ART for more than 12 months. The main objective was to assess the prevalence of facial LA in this population. Additional objectives were to make the same assessments for nonfacial LA and lipohypertrophy. The presence of LD signs, type, and severity was assessed by clinicians and compared with patient self-evaluations through two questionnaires. A total of 2,131 assessable patients had a median age of 46 years and a median time on ART of 10 years. Physicians diagnosed facial LA in 54% of patients and these subjects had received ART for a longer duration than those without LA. Thymidine analog usage was associated with an increased likelihood of facial LA, but 28% of patients recently treatment-initiated (1-5 years) were also affected. At other sites, LA and lipohypertrophy were diagnosed in 59% and 57% of cases, respectively. The concordance between physician and patient assessments was good for facial and buttocks LA. In this study, facial LA affects more than half of the subjects and is frequent even among the most recently treated patients. The prevalence of facial LA significantly increases with the duration of ART, with male gender, hepatitis C virus (HCV) coinfection, and non-African origin being independent risk factors. Lipohypertrophy is frequent and appears early after ART initiation.

[Lipodystrophy and echographic hepatic steatosis in HIV-positive patients under highly active antiretroviral therapy (HAART) in Yaounde (Cameroon)]

The association between sonographic liver steatosis and clinical lipodystrophy in AIDS patients treated by highly active antiretroviral therapy (HAART) has been studied. We conducted a cross-sectional study reviewing medical files of 117 AIDS patients followed up in Yaounde, Cameroon (6.3 F/1 M, mean age = 40 ± 9.4 years), and treated the patients with HAART protocol comprising stavudine or zidovudine for at least six months. All participants underwent abdominal ultrasonography and anthropometric assessment including body mass index (BMI). Data analysis included determining the association between sonographic liver steatosis, clinical lipodystrophy, and other clinical and biological data using the ¢(2) test, and the calculation of odd ratio. Fifty-one patients presented clinical lipodystrophy. The sonographic prevalence of hepatomegaly and splenomegaly was 70.1% and 25.6%, respectively. The overall prevalence of sonographic steatosis was 28.2%; specifically 37.3% among lipodystrophic patients and 21.1% among nonlipodystrophic patients (P = 0.03). According to the type of lipodystrophy, the prevalence was 40.6% among lipohypertrophic patients, 38.5% among lipodystrophic patients, and 16.7% among lipoatrophic patients. Clinical lipohypertrophy was statistically associated with a higher prevalence of sonographic steatosis (odd ratio = 2.5; 95% CI: [1.01-6.39], and P = 0.04). HAART protocol including stavudine was associated with lipodystrophy. The prevalence of sonographic liver steatosis is high among AIDS patients under HAART and is associated with lipohypertrophy.

The induction of a nucleoplasmic reticulum by prelamin A accumulation requires CTP:phosphocholine cytidylyltransferase-α

Farnesylated prelamin A accumulates when the final endoproteolytic maturation of the protein fails to occur and causes a dysmorphic nuclear phenotype; however, the morphology and mechanisms of biogenesis of these changes remain unclear. We show here that acute prelamin A accumulation after reduction in the activity of the ZMPSTE24 endoprotease by short interfering RNA knockdown, results in the generation of a complex nucleoplasmic reticulum that depends for its formation on the enzyme CTP:phosphocholine-cytidylyltransferase-α (CCT-α, also known as choline-phosphate cytidylyltransferase A). This structure can form during interphase, confirming that it is independent of mitosis and therefore not a consequence of disordered nuclear envelope assembly. Serial-section dual-axis electron tomography reveals that these invaginations can take two forms: one in which the inner nuclear membrane infolds alone with an inter membrane space interior, and the other in which an invagination of both nuclear membranes occurs, enclosing a cytoplasmic core. Both types of invagination can co-exist in one nucleus and both are frequently studded with nuclear pore complexes (NPC), which reduces NPC abundance on the nuclear surface.

[Adipose tissue hypertrophy after Lipostructure in HIV patient with antiretroviral treatment. Case report and literature review]

HIV-related facial atrophy is a common complication due to antiretroviral treatment. The social handicap due to this lipodystrophy increase the demand of surgical correction. The usual treatment is the Lipostructure described by Coleman. The hypertrophy is one of the complications which can occur after a correction by Lipostructure. This complication is different from the overcorrection by the free time before his appearance. The treatment by liposuction is possible but there is a high risk of recurrence. The best treatment, after the literature review, seems to be the direct excision.

IRM du tissu adipeux abdominal et lipodystrophie VIH, étude cas-témoin

PURPOSE

To characterize intra-abdominal adipose tissue changes in HIV patients with clinical lipodystrophy using a reproducible imaging technique. Materials and methods. 89 HIV patients with clinical lipodystrophy were included. A single axial T1W image was acquired at the mid L4 vertebral level. Two radiologists measured subcutaneous (SAT) and visceral (VAT) adipose tissues using a semi-automated method. Measurements were compared to a matched population (race, sex, age and BMI).

RESULTS

Measurements of abdominal adipose tissue on MRI are reproducible. Three clinical types of lipodystrophy are described in males with increased visceral (VAT) and reduced subcutaneous (SAT) adipose tissues compared to control subjects. Two clinical types of lipodystrophy are described in females with increased visceral (VAT) and unchanged subcutaneous (SAT) adipose tissues.

CONCLUSION

MRI with comparison between HIV patients and normal control subjects is a reproducible method to characterize adipose tissue changes of lipodystrophy and evaluate its severity. Evaluation of a adipose tissue distribution in a large control population would be helpful to the study of metabolic disorders.