[Hypertension and cardiovascular risk associated with obstructive sleep apnea in adult in Guadeloupe (French West Indies)]. / Hypertension artérielle et risque cardiovasculaire associés au syndrome d'apnées obstructives du sommeil chez l'adulte en Guadeloupe.

BACKGROUND AND PURPOSE: In Guadeloupe, data on the relationships between arterial hypertension and obstructive sleep apnea are unavailable. The aim of this study was: to assess the frequency of hypertension and non-dipper pattern evaluated by 48-hour ambulatory blood pressure monitoring in an adult population identified obstructive sleep apnea/non-obstructive sleep apnea during overnight polygraphy ; to determine the cardio-metabolic factors associated with obstructive sleep apnea. DESIGN AND METHOD: A cross-sectional study was realized at Pointe-à-Pitre Hospital. Patients were referred for suspected sleep apnea to sleep specialist and performed a nocturnal polygraphy. Diagnosis was confirmed if the apnea-hypopnea index was ≥ 5. We obtained two groups: sleep apnea/non-sleep apnea. All patients underwent 48-hour ambulatory blood pressure monitoring. The cardio-metabolic factors were identified and assessed (fasten level of hs-CRP and Homa-IR index). RESULTS: A total of 204 patients were included. Mean age at diagnosis was 54 ± 10 years, 63% were women. OSA was present in 69.6% with a higher frequency in men than in women. Difference was not significant between the two groups for hypertension frequency (84.5% vs 77%; P=0.22), non-dipper pattern (77.5% vs 76%; P=0.79) and hs-CRP. Differences for age, snoring, body max index, mean waist circumference, Homa-IR index, obesity, dyslipidemia, and type 2 diabetes were significant. CONCLUSIONS: Our data highlight raised frequency of cardiovascular metabolic factors in patients with obstructive sleep apnea and confirm their high cardiovascular risk.

Silent myocardial ischaemia and risk factors in a diabetic Afro-Caribbean population.

AIMS: In Guadeloupe, an island in the French West Indies, diabetes has a prevalence recently reported to be 10%. Myocardial ischaemia is more frequently silent in diabetics, and needs to be screened for and monitored, once identified. This study aimed to evaluate the prevalence of silent myocardial ischaemia (SMI) in a diabetic population and to analyze its associated cardiovascular risk (CVR) factors. METHODS: This was a cross-sectional study of 147 patients with associated CVR factors, defined according to the 2004 SFC/ALFEDIAM guidelines. Exercise stress tests, myocardial performance imaging and stress echocardiography were performed. Ancova and logistic regression were used in the statistical analyses. RESULTS: The patients' mean age was 62 years, and 53% were male. Mean duration of diabetes was 14 years. Overall, 23.1% had SMI, and these patients more frequently had a personal history of cardiovascular disease vs those without SMI. On multivariate logistic-regression analyses, the adjusted odds ratios of SMI were significantly increased in patients with a personal history of cardiovascular disease (4.36, 95% CI: 1.36-13.96; P=0.01) and left ventricular hypertrophy (LVH) (2.46, 95% CI: 1.03-5.86; P=0.04). CONCLUSION: The prevalence of SMI in our Afro-Caribbean diabetic population was 23.1%. Searching for a personal history of cardiovascular disease and LVH may help to identify patients who need to be screened for SMI.

Vitamin D deficiency, vitamin D receptor gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes.

AIM: The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D). METHODS: In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed. RESULTS: The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (<20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA(1c), although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P<0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P=0.02) and the aa genotype of ApaI (OR: 0.46; P=0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency. CONCLUSION: The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.

Adiponectin and leptin in Afro-Caribbean men and women with HIV infection: association with insulin resistance and type 2 diabetes.

AIM: Insulin resistance and type 2 diabetes (T2D) are commonly seen in human immunodeficiency virus (HIV) infection and are related to antiretroviral therapy. Adiponectin and leptin secreted by adipocytes are both linked to body-fat distribution and insulin sensitivity. The present study aimed to assess the prevalence of insulin resistance and T2D, and their association with adiponectin and leptin, in Afro-Caribbean men and women with HIV infection. METHODS: This cross-sectional study was conducted in an unselected sample of 237 HIV-1-infected patients. Clinical and metabolic parameters were measured, including fasting and postload plasma insulin, and circulating adiponectin and leptin levels. Insulin resistance was estimated by homoeostasis model assessment (HOMA-IR). Adjusted multiple logistic regressions were used to estimate the association of insulin resistance with adipokine levels and patients' characteristics. RESULTS: A total of 132 men (mean age: 49 years) and 105 women (mean age: 48 years) were included in the study. Prevalences of T2D and insulin resistance were higher in women than in men [16.2% vs 8.3% (P = 0.06) and 24% vs 9.9% (P < 10⁻³), respectively]. Abdominal obesity was found in 47% of women and in 7% of men (P < 10⁻4). Insulin resistance was independently associated with adiponectin in women and with leptin in men. CONCLUSION: Insulin resistance is frequent in Afro-Caribbean women with HIV infection. Overweight and obesity are major risk factors in such a population. Systematic screening for insulin resistance should be carried out in this population, which has a high prevalence of T2D.

Gabapentin premedication: assessment of preoperative anxiolysis and postoperative patient satisfaction.

BACKGROUND: Gabapentin reduces anxiety in psychiatric patients. In this prospective, randomized, double-blinded, placebo-controlled study, we investigated whether a single dose of gabapentin as a premedicant reduces preoperative anxiety, and improves patient satisfaction. MATERIALS AND METHODS: After Institutional Review Board approval and written consent, 210 patients were randomly allocated into 3 groups of oral premedication: placebo, hydroxyzine 75 mg, or gabapentin 1200 mg. Anxiety level was assessed 3 times, using a 100-mm visual analogue scale: before premedication, in the preoperative holding area, and just before induction of general anaesthesia. In the postoperative period, patients were asked about their satisfaction with their premedicant. Data were presented as mean +/- SD. VAS scores were analyzed by repeated-measures analysis of variance followed by a Bonferroni test as appropriate. The chi-square test was used to analyze categorical data. All p values less than 0.05 was considered statistically significant. RESULTS: Baseline anxiety was not statistically different among the 3 groups. Anxiety level in the gabapentin group was significantly lower in the holding area, and before induction of anaesthesia (20 mm +/- 21), than in the hydroxyzine group (33 mm +/- 26 ; p = 0.023) and in the placebo group (36 mm +/- 28; p = 0.004). Anxiety decreased significantly overtime only in the gabapentin group. The gabapentin and hydroxyzine groups had a higher proportion of "satisfied or extremely satisfied" patients (73% and 70% respectively) as compared to the placebo group (48%, p = 0.006). CONCLUSION: A single dose of gabapentin has proven to be an effective premedication to reduce preoperative anxiety.

Left ventricular hypertrophy in hypertensive type 2 diabetic patients according to renal function.

AIM: Cardiovascular disease is the main cause of death in diabetic patients undergoing haemodialysis. Dialysis and hypertension increase left ventricular hypertrophy (LVH), a strong predictor of cardiovascular events. This study evaluated left ventricular structure and function in three groups of hypertensive type 2 diabetic patients with different renal function, and assessed the factors associated with LVH, in an Afro-Caribbean population. METHODS: Left ventricular structure and function were measured by ultrasonography. Group 1 consisted of 150 patients with normal renal function, group 2 included 183 patients with renal dysfunction and the third group comprised 75 dialysis patients. RESULTS: Left ventricular mass/height(2.7) increased from group 1 to groups 2 and 3 (49.00g/m(2.7), 57.12g/m(2.7) and 59.75g/m(2.7), respectively; P<0.0001). The prevalences of LVH were 48.3% in group 1, 64.8% in group 2 and 70.3% in the dialysis patients (P=0.001). LVH was more concentric than eccentric in groups 2 and 3. The factors significantly associated with LVH were obesity in groups 1 and 2, and an increase of 10mmHg in pulse pressure in groups 2 and 3, according to multivariate logistic-regression analysis. CONCLUSION: Our study confirmed that, in a population of Afro-Caribbean hypertensive type 2 diabetic patients, renal failure was associated to an increased left ventricular mass/height(2.7). The data show that the variables associated with LVH differ according to renal profile. This finding will be of value in the treatment and follow-up of these patients.

Metabolic syndrome and Framingham risk score for prediction of cardiovascular events in Caribbean Indian patients with blood glucose abnormalities.

OBJECTIVE: To evaluate the metabolic syndrome (MS) and Framingham risk score (FRS) as predictors of cardiovascular (CV) events in Caribbean Indian patients who have type 2 diabetes (T2D) or impaired glucose tolerance (IGT). METHOD: A longitudinal and retrospective study was conducted involving patients classified as T2D or IGT in a first study in 1997 who responded for a second examination in 2006. Nonparametric tests and Cox's proportional hazards model were used. Hazard ratios (HRs) and their confidence intervals (95% CI) for risk of a first CV event, according to the presence of MS or a high FRS, were estimated. For MS, the models were adjusted for age, gender and smoking status. RESULTS: A total of 148 patients were included in the present study. The mean time without a CV event was 7.5 years (range 0.38-8.45 years). We noted 31 (25 nonfatal) first hospitalizations, for stroke (n=15), angina pectoris (n=8), acute coronary heart disease (n=7) and acute peripheral vascular disease (n=1). Ten (6.8%) patients died and six deaths were related to CV events. The HRs of CV events associated with metabolic syndrome, defined by the National Cholesterol Education Program's Adult Treatment Program III, were not significant. Conversely, HRs of CV events associated with the FRS were 4.78 (95% CI 1.65-13.5) and 2.94 (95% CI 1.42-6.06) for a risk score superior or equal to 10% and superior or equal to 20%, respectively. For coronary heart disease alone, the HRs associated with the FRS were 9.92 (95% CI 1.31-75.2) and 2.88 (95% CI 1.05-7.93), respectively. In these Caribbean Indian patients with blood glucose abnormalities, unlike the FRS, MS failed to identify subgroups at high cardiovascular risk in the short term (8.5 years). Nevertheless, the long-term risk-predictive value of these tools needs to be evaluated.

[Hypertension in the metabolic syndrome among Caribbean non diabetic subjects]. / Place de l'hypertension artérielle dans le syndrome métabolique chez des sujets non diabétiques caribéens.

OBJECTIVE: To study the metabolic syndrome (MS) components in Caribbean non diabetic individuals and to determine the magnitude of hypertension (HT) in those with and without MS. RESEARCH METHODS: We conducted a cross-sectional study, of 966 consecutive subjects aged 18-74 years. The MS was identified according to the NCEP/ATpiiI definition. Age, gender, body mass index and the MS components (blood pressure, waist circumference, fasting blood glucose, triglycerides, HDL cholesterol) were taken into account. The Principal component analysis (PCA) was used to understand correlations between these continuous variables within the data base, and to identify principal factors (combinations of variables) and the magnitude of HT in these combinations. RESULTS: In the overall study population, mean age was 38 years and there were 60.1% of women. HT was more frequently found in men than in women (52.2% vs. 41.3%; p=0.001). Prevalence of MS was 11.3%. With PCA, in the complete sample of men, the first factor, explained 31.5% of the total variance in the original variables and was dominated by blood pressure, clustered with age and fasting blood glucose (FBG). In the women's sample, the first factor (31.1% of the variance) was dominated by obesity combined with FBG and lipids. In subjects with the metabolic syndrome the principal factors were dominated by blood pressure in both genders with higher loadings in men than in women. CONCLUSION: In this non diabetic population study the prevailing obese women profile clustering with fasting glucose and lipid disturbances might explain the higher prevalence of type 2 diabetes among women, observed in this Caribbean region.

Metabolic syndrome components in Indian migrants with type 2 diabetes. A matched comparative study.

OBJECTIVE: To study the metabolic syndrome (MS) in Indian subjects with type 2 diabetes (T2D) in comparing them with controls from the Indian community and from the general population. METHOD: An adapted definition of MS by the Third report of the National Cholesterol Education Program's Adult Treatment Panel III was used. We defined three groups matched for sex and age (+/-5 years). Non parametric tests for comparison of matched samples and conditional logistic regression were used. RESULTS: We selected 71 Indians with T2D (group 1) and two control groups with fasting blood glucose<6.1 mmol/L: 71 Indians (group 2) and 213 subjects from the general population (group 3). Patients were 24 to 76 years-old and each group contained 56% men. Globally, MS was identified in 77% of the group 1 when diabetes was taken into account. When diabetes was excluded there were 47% of MS in group 1, 18% in group 2 and 16% in group 3. The clusters of four factors (hypertension, large waist circumference, hypertriglyceridemia and Low HDL-C) were more common in Indians. The most frequent factors were hypertriglyceridemia and large waist circumference in Indians. Indians with T2D had a 5-fold higher risk of MS than the general population group, OR (95% CI): 4.93 (2.71 - 8.97); P<0.001. CONCLUSION: The high frequency of MS and of hypertriglyceridemia in Indians with T2D highlights the need for screening and management of MS in this population facing a high cardiovascular risk.

Anthropometric parameters and type 2 diabetes: a case-control study in a Guadeloupean population.

OBJECTIVE: The aim of this study was to quantify the association between three anthropometric parameters and type 2 diabetes in an adult population in Guadeloupe and to evaluate the effect of age on these associations. DESIGNS AND METHODS: We conducted a case-control study in a population recruited in an Health Center of Guadeloupe in Year 2000. A total of 309 subjects with documented type 2 diabetes were matched on sex and age (+/- 2 Years) with controls free of any glycemic abnormality. Student t-test was used and conditional logistic regressions were performed separately for men and women to quantify the association between type 2 diabetes and the explanatory variables, body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC). RESULTS: Mean (SD) WC was 89.0 cm (0.9) in non diabetics men and 97.3 cm (1.1) in diabetics ones, p<10-4. In women, it was 87.7 (0.8) cm for non diabetics and 96.3 cm (0.9) for diabetics. This difference was persistent for any tertile of age in each sex. It was discordant for BMI and WHR at higher tertile for men and women. In the multivariate analysis, Odds ratio[CI95%] for WC was 9.67 [2.32-40.20] in men and 2.97 [1.70-5.19] in women. It was 2.94 [0.99-8.74] in men and 6.15 [3.11-12.17] in women for WHR. Results for BMI were non significant in both sex. CONCLUSION: Differences between WC and WHR over age groups and sex in predicting type 2 diabetes should be taken into account when using these parameters routinely in medical practice.

[Viral seroprevalence, transfusion and alloimmunization in adults with sickle cell anemia in Guadeloupe]. / Séroprévalence virale, transfusion et allo-immunisation chez des adultes drépanocytaires guadeloupéens.

We retrospectively studied the prevalence of anti HIV 1 and 2, anti-HTLV-I, anti-Hepatitis B and C viruses (HBV and HCV) antibodies, anti-HBV vaccinal coverage, transfused patients and alloimmunizations frequencies among adult sickle cell patients attending the sickle cell center (SCC) of Guadeloupe. The data were collected from the medical files of the centre. Among the studied samples (n = 331) no transfusional HIV contamination was observed. All patients with HTLV-I (n = 11, 3.3% of whole sample) and anti-HCV (n = 9, 2.7%) positive serology had transfusion history. Five patients (1.5%) had an active hepatitis B. Vaccination against HBV efficiently protected 247 patients (74.4%) and 57 had post-hepatitis B antibodies. We observed that 213 patients (64%) had a history of transfusion (88% of SS patients and 36% of the SC patients, p < 0.05). Fifty-four patients (16%) presented alloimmunization, 4 of them have never been transfused. These results show that it is still necessary to optimise transfusion protocol and their safety, and to diagnose viral contamination in transfused sickle cell patients.

Hypertension and combinations of cardiovascular risk factors. An epidemiologic case-control study in an adult population in Guadeloupe (FWI).

Our aim was to quantify the association between hypertension and four well-known cardiovascular risk factors (obesity, dyslipidemia, high blood glucose, smoking) and to determine the extent of their combinations in hypertensive subjects in an adult population in Guadeloupe (FWI). A case-control study was conducted in 1999. Odds ratios (ORs) and 95% confidence interval (95% CI) of hypertension according to cardiovascular risk factors were calculated by a logistic regression model. In all, 4210 subjects were included in the study: 2105 hypertensives and 2105 age and sex matched non-hypertensive controls. In the hypertensives, obesity (30%) was the most frequent risk factor followed by dyslipidemia (23.2%), current smoking (11.5%) and high blood glucose (8.2%). But, prevalence of current smokers was higher in normotensives (13.9 vs. 11.5%, p < 0.01). Among cases, 44.5% had no risk factor other than hypertension. The proportion of subjects with multiple risks factors (< or = 2) was higher in hypertensives than in controls (55.5 vs. 6.5%,p < 0.001) and higher in women than in men in cases (58.1 vs. 51.8%, p = 0.005). The adjusted ORs (95% CI) of hypertension were 2.41 (2.02-2.88) for obesity, 1.39 (1.16-1.66) for dyslipidemia and 1.67 (1.20-2.32) for high blood glucose. Our study documents the high prevalence of combinations of cardiovascular risk factors in hypertensive subjects in Guadeloupe and confirms the need of a global risk approach in prevention and treatment of hypertension.

Risk factors associated with ischaemic stroke in Guadeloupe

We carried out a case control study at the University Hospital of Pointe-Ó-Pitre, Guadeloupe, during eight months. Seventy patients with ischaemic stroke and seventy age- and sex-matched controls were involved. A standard questionnaire reported clinical characteristics and medical history. Seventy-six per cent of patients suffered from hypertension. Obesity and diabetes were more frequent in the case group than in the control group. Serum creatinine concentration (86 vs 74 mumol/l; p < 0.001), total cholesterol (5.9 vs. 5.2 mmol/l; p < 0.001), apolipoprotein B (1.2 vs 1.0 g/l; p < 0.001) and lipoprotein (a) (82 vs 48 mg/dl; p < 0.001) were significantly higher in patients than controls. Multiple logistic regression analysis revealed that in addition to serum creatinine, serum apolipoprotein B, hypertension, obesity, serum lipoprotein (a) and diabetes mellitus were associated independently and significantly with ischaemic stroke. These findings have implications for clinical practice and further research particularly with respect to serum creatinine concentration as a marker of renal damage from hypertension and as a risk factor itself for cerebrovascular disease.

Risk factors associated with ischaemic stroke in Guadeloupe

We carried out a case control study at the University Hospital of Pointe-a-Pitre, Guadeloupe, during eight months. Seventy patients with ischaemic stroke and seventy age- and sex matched controls were involved. A standard questionnaire reported clinical characteristics and medical history. Seventy-six per cent of patients suffered from hypertension. Obesity and diabetes were more frequent in the case group than in the control group. Serum creatinine concentration (86 vs 74umol/l; p <0.001), total cholesterol (5.9 vs 5.2 mmol/l; p < 0.001), apolipoprotein B (1.2 vs 1.0 g/l' p < 0.001) and lipoprotein (a) (82 vs 48 mg/dl; p< 0.001) were significantly higher in patients than controls. Multiple logistic regression analysis revealed that in addition to serum creatinine, serum apolipoprotein B, hypertension, obesity, serum lipoprotein (a) and diabetes mellitus were associated independently and significantly with ischaemic stroke. These findings have implications for clinical practice and further research particularly with respect to serum creatinine concentration as a marker of renal damage from hypertension and as risk factor itself for cerebrovascular disease.(Au)

[Blood pressure in Guadeloupe. Analysis according to classification criteria of the 6th report of the Joint National Committee]. / La pression artérielle en Guadeloupe. Analyse selon les critères de classification du sixième rapport du Joint National Committee.

OBJECTIVES: To study blood pressure distribution according to the new classification criteria of the JNC VI. To study the other cardiovascular risk factors related to blood pressure stage. METHOD: A cross sectional survey was undertaken in a medical center in Guadeloupe in 1999. The study included 1016 consecutive adult subjects. Blood pressure measurements were done with an automated oscillometric method (dynamap). RESULTS: A total of 609 women and 407 men participated in the study. Hypertension (systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg or being on antihypertensive medication) was present in 326 subjects (32.1%). Hypertension was more frequently found in men than in women (p = 0.008). Over the whole sample, 53.1% had optimal or normal blood pressure, 14.9% had high normal blood pressure, 16.1% were stage 1 hypertension and 15.9% were stage 2 or 3 hypertension or were on antihypertensive medication. Prevalence of hypercholesterolemia (total cholesterol > or = 240 mg/dl) increased significantly with increasing blood pressure in men (p = 0.002) and women (p < 0.001). Prevalence of dyslipidemia (total cholesterolemia > or = 240 mg/dl or HDL-cholesterol < 35 mg/dl or currently receiving antihyperlipidemic therapy) increased significantly with increasing blood pressure in both sex (p < 0.001). The same trend was found for prevalence of obesity (BMI (30 kg/m2) in both sex (p < 0.01). CONCLUSION: In this population with a high prevalence of hypertension, we showed that hypercholesterolemia and obesity increased significantly with increasing blood pressure. We also showed that caring for high blood pressure should be part of a global caring of the patient looking for other cardiovascular risk factors.

[Survival analysis of diabetic patients on dialysis in Guadeloupe]. / Survie des patients diabétiques dialysés en Guadeloupe.

BACKGROUND: Both diabetes and hypertension, two conditions that can lead to renal failure, have a high prevalence in Guadeloupe. OBJECTIVE: To determine the clinical and epidemiological features of diabetic patients on end stage renal failure and to evaluate their survival. PATIENTS AND METHOD: Data of the Guadeloupe Kidney registry were analysed for patients who began chronic dialysis during 1978-1997. Follow up information on survival status was obtained up to January 26(th) 1999. Cox proportional hazard analysis was used to determine the relative risk (RR) of death between levels of independant variables. RESULTS: There were 784 dialysis patients of whom 174 (22%) were diabetics. Among the latter, there were 97 women (55,7%), mean age at the start of dialysis was 60.6 years (range 26-83) and arterial hypertension was present before the start of dialysis in 67% of them. Median survival MS (95%CI) was significantly lower in diabetics 42 months (31-52) than in non diabetics 83 months (70-96), p<10(-4). In diabetics, the cumulative probability of survival was 83% (1 year) and 39% (5 years) and the RR of death (95% CI) were 1.90 (1.10-3.22) and 3.43 (2.00-5.87) for diabetics admitted in dialysis in age-class 55-64 years and 65-83 years, respectively, when that for age-class 54 years was set at 1. 00. The RR for diabetics was 1.67 (1.33-2.10) relative to non diabetics. CONCLUSION: Prospective studies are warranted to describe the role of comorbid conditions in diabetic patients survival. Prevention of degenerative complications should be a priority in this population.

Trends of AIDS in Guadeloupe (French West Indies) a longitudinal survey from 1988 to 1997.

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1988 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses was calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8%) and 367 deaths (20.7%) were reported. For 32.1% of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS diagnosis was 11.8 months (95% Confidence Interval (CI), 95% CI 10.2-14.1). After this date median survival increased to 17.8 months (95% CI 18.6-22.5) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months, Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p < 0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH: 1.17, 95% CI 1.07-1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95% CI 1.32-2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95% CI 1.71-3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH: 0.68, 95% CI 0.52-0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95% CI 0.13-0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.

Trends of AIDS in Guadeloupe (French West Indies): a longitudinal survey from 1998 to 1997

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.

Trends of AIDS in Guadeloupe (French West Indies): A longitudinal survey from 1998 to 1997

The study objective was to describe morbidity and mortality from HIV infection and the acquired immunodeficiency syndrome (AIDS) in Guadeloupe from 1998 to 1997 and to evaluate survival and prognostic factors. The HIV infected patients database of Guadeloupe included 1771 adult patients up to December 31, 1997. Annual incidence of AIDS defining illnesses were calculated and compared using Poisson regression. Survival analysis with log-rank test and multivariate analysis with Cox's model were performed for patients with AIDS. At the end of December 1997, 599 cases of AIDS (33.8 percent) and 367 deaths (20.7 percent) were reported. For 32.1 percent of the patients, AIDS was diagnosed before inclusion. Incidence of most AIDS-defining events decreased over time, especially after the introduction of protease inhibitor therapy. Before the introduction of protease inhibitors in September 1996, overall median survival after AIDS was 11.8 months (95 percent Confidence Interval (CI), 95 percent CI 10.2 - 14.1.) After this date median survival increased to 17.8 months (95 percent CI 18.6 - 22.5 ) and probability of survival was significantly higher for patients treated with protease inhibitor in combination regimen (mean 19.0 months. Standard deviation (SD) 1.3) compared to those who were not (mean 7.9 months, SD 0.6, p<0.0001). Prognosis factors of death after AIDS were older age (Relative Hazard, RH : 1.17, 95 percent CI 1.07 - 1.28), occurrence of two or more AIDS-defining events at the beginning of the disease (RH: 1.70, 95 percent CI 1.32 - 2.19), and a CD4 cell count less than 50/mm3 (RH: 2.33, 95 percent CI 1.71- 3.17). On the other hand, occurrence of AIDS during follow-up had a better prognosis (RH : 0.68, 95 percent CI 0.52 - 0.89) and protease inhibitor therapy was strongly associated with a longer survival (RH 0.26, 95 percent CI 0.13 - 0.53). We concluded that HIV infection in Guadeloupe was frequently diagnosed at the stage of AIDS. However, survival of patients and trends of major AIDS defining illnesses were more similar to the European pattern than to the Caribbean one, as a consequence of the availability of modern therapy.(AU)