Serum lipid profile in highly active antiretroviral therapy-naïve HIV-infected patients in Cameroon: a case-control study.

BACKGROUND: HIV status has commonly been found to affect the serum lipid profile. OBJECTIVES: The aim of this study was to determine the effect of HIV infection on lipid metabolism; such information may be used to improve the management of HIV-infected patients. METHODS: Samples were collected from December 2005 to May 2006 at Yaounde University Teaching Hospital, Yaounde, Cameroon. Lipid parameters were obtained using colorimetric enzyme assays, while low-density lipoprotein cholesterol (LDLC) values were calculated using the formula of Friedewald et al. (1972) and atherogenicity index by total cholesterol (TC)/high-density lipoprotein cholesterol (HDLC) and LDLC/HDLC ratios. RESULTS: HIV infection was most prevalent in subjects aged 31 to 49 years. Most of the HIV-positive patients belonged to Centers for Disease Control and Prevention categories B (43.0%) and C (30.23%). Compared with control subjects, patients with CD4 counts<50 cells/microL had significantly lower TC (P<0.0001) and LDLC (P<0.0001) but significantly higher triglyceride (TG) values (P<0.001) and a higher atherogenicity index for TC/HDLC (P<0.01) and HDLC/LDLC (P=0.02); patients with CD4 counts of 50-199 cells/microL had significantly lower TC (P<0.001) and significantly higher TG values (P<0.001); patients with CD4 counts of 200-350 cells/microL had significantly higher TG (P=0.003) and a higher atherogenicity index for TC/HDLC (P<0.0002) and HDLC/LDLC (P=0.04); and those with CD4 counts >350 cells/microL had a higher atherogenicity index for TC/HDLC (P<0.0001) and HDLC/LDLC (P<0.001). HDLC was significantly lower in HIV-positive patients irrespective of the CD4 cell count. Lipid parameters were also influenced by the presence of opportunistic infections (OIs). CONCLUSION: HIV infection is associated with dyslipidaemia, and becomes increasingly debilitating as immunodeficiency progresses. HDLC was found to be lower than in controls in the early stages of HIV infection, while TG and the atherogenicity index increased and TC and LDLC decreased in the advanced stages of immunodeficiency.

Risk factors and complications of hypertension in Yaounde, Cameroon.

AIM: To determine the risk factors and complications of hypertension, isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) in Yaounde. METHODS AND RESULTS: Between January and September 1998 we examined 813 consecutive adult patients (46.5% men) in the Yaounde University Teaching Hospital, with special focus on risk factors of hypertension and clinical findings in the cardiovascular system. We measured systolic blood pressure, diastolic blood pressure, body mass index and plasma glucose, and recorded chest X-ray, electrocardiogram and echocardiogram. Hypertension, ISH and IDH were defined using the WHO-ISH 1999 criteria. After controlling for the confounding effects of age and sex, hypertension was significantly associated with obesity, family history of hypertension, alcohol intake, heart failure, stroke and left ventricular hypertrophy (p < 0.01); smoking was significantly associated with ISH (p = 0.04), and no factor was independently associated with IDH. CONCLUSIONS: A prevention strategy for hypertension and its resultant complications in Cameroon should include measures aimed at obesity and alcohol consumption, as well as early diagnosis with the institution of effective and affordable therapy.

Cutaneous manifestations of systemic lupus erythematosus.

We have assessed the cutaneous signs in 73 patients with systemic lupus erythematosus (SLE), seen during a 5-year period in an English hospital. Most previous information about the cutaneous manifestations of SLE has been obtained from studies performed in the U.S.A. We classified lesions as specific cutaneous and mucosal LE (acute, subacute and chronic) or non-specific LE-related, e.g. photosensitivity, urticaria, erythema, Raynaud's phenomenon or vasculitis. Acute cutaneous LE lesions included a butterfly rash with erythematous macules, telangiectasia or papulosquamous lesions, seen in 37 patients (51%) and facial oedema seen in four patients (5%). Five patients (7%) had psoriasiform subacute cutaneous LE. Chronic cutaneous LE was common: 18 patients (25%) had chronic discoid lesions (DLE) and, in 12 (15%), these had preceded systemic disease. One patient had facial lupus profundus. Ten patients (14%) had scarring alopecia secondary to DLE. Fifteen patients (20.5%) had chronic chilblain lupus. Twenty-three patients (31.5%) had a history of mouth ulceration. Of these, 11 (15%) gave a history of ulcers at the onset of their disease. Three (4%) had erythema and superficial ulceration of the palate, not typical of aphthous ulcers, and three (4%) had chronic buccal plaques. Cheilitis due to DLE was seen in three (4%), episcleritis in three (4%), five (7%) had nasal disease, six (8%) bullous skin eruptions, one 'the bullous eruption of SLE', four bullae associated with cutaneous vasculitis, and one bullae associated with ultraviolet radiation. Forty-six (63%) observed photosensitivity. A non-scarring alopecia occurred in 29 (40%). Vascular phenomena were common: three patients (4%) had chronic palmar erythema, Raynaud's phenomenon occurred in 44 patients (60%), chronic urticaria, worsened by sun exposure, was noted by 32 (44%) (in whom the lesions often lasted more than 36 h), eight (11%) had cutaneous vasculitis and three (4%) livedo reticularis. Skin changes play a prominent part in SLE and may provide helpful diagnostic information. In this British population, chilblains and urticaria were particularly common. Lesions of subacute cutaneous LE were relatively unusual in this group of patients with SLE.

Serological and epidemiological studies of hepatitis B and human immunodeficiency virus in a dialysis unit of Africa.

Hepatitis B infection is endemic in the tropics. Human immunodeficiency virus infection might also be endemic in parts of Africa. Blood transfusion is a major risk factor in the transmission of either virus. Patients with end stage chronic renal failure undergoing dialysis receive multiple blood transfusions. Three of twelve haemodialysed patients in a renal unit were found to carry the hepatitis B surface antigen. No patient on continuous ambulatory peritoneal dialysis, no patient with a Kidney transplant bore that antigen. Five out of twelve haemodialysed patients and only one out of seven patients on continuous ambulatory peritoneal dialysis were positive for the hepatitis B surface antibody. No transplanted patient bore this antibody. This status remained unchanged for a year. Only one patient who initially was H.I.V. negative converted to positivity a year after.

PIP: Hepatitis B infection is endemic in the tropics. Human immunodeficiency virus (HIV) infection might also be endemic in parts of Africa. Blood transfusion is a major risk factor in the transmission of either virus. Patients with end-stage chronic renal failure undergoing dialysis receive multiple blood transfusions. 3 of 12 hemodialyzed patients in a renal unit were found to carry the hepatitis B surface antigen. No patient on continuous ambulatory peritoneal dialysis and no patient with a kidney transplant bore that antigen. 5 of 12 hemodialyzed patients and only 1 of 7 on continuous ambulatory peritoneal dialysis were positive for the hepatitis B surface antibody. This status remained unchanged for 1 year. Only 1 patient who was initially HIV negative converted to HIV positive a year later.