High Rate of Asymptomatic Myocardial Ischemia in HIV Infected Population in Bobo-Dioulasso in Burkina Faso

1. Polytechnic University of Bobo-Dioulasso, Higher Institute of Health Sciences, Bobo-Dioulasso, Burkina Faso 2. Centre Muraz of Bobo-Dioulasso, Burkina Faso 3. Department of Infectious Diseases and Day hospital CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso 4. University of Ouagadougou, Training and Research Unit in Health Sciences (UFR / SDS) 5. Service of infectious diseases at Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso 6. Service of Cardiology of the University Hospital Souro Sanou, Bobo-Dioulasso, Burkina Faso 7. Service of Cardiology at Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso


Introduction:
The cardiovascular risk in patients infected by the Human Immunodeficiency Virus (HIV) will become in the future years, an increasingly significant concern for the doctors dealing with this infection because of the success of the antiretroviral treatment (ART). This concern involves a considerable lengthening of the survival of infected patients but also of the side effects of the ART. Since the appearance of the Highly Active Anti-Retroviral Treatment (HAART), the spectrum of the cardiologic attack during the infection by HIV was modified. It is now a question of facing the complications related to the antiretroviral treatment, in particular the acceleration of the atherosclerosis (coronary disease, arteriopathy of the lower limbs, cerebral vascular accident) [1][2][3]. EEEpidemiologic studies showed that the incidence of the myocardial infarction is higher in HIV infected population than in the general population [4,5]. In Africa the frequency of the coronary disease in patient infected by HIV is not well-known and some rare cases are reported in hospital series [6,7]. The coronary disease is following the example of other metabolic diseases (Diabetes) which can be asymptomatic and of a fortuitously discovery. This study aimed at describing the frequency of asymptomatic myocardic ischemia in a population of patients infected by HIV under ART.

Patients and methods
The study was carried out in the HIV clinic of the department of medicine of the CHU Sanou Sourô (CHUSS) of Bobo-Dioulasso.
This was This was a descriptive cross-sectional study which was conducted from November 2 nd to November 30 th , 2015.
The target population were the patients followed in routine in the cohort of patients infected by HIV and are from the HIV clinic of CHUSS. It is a cohort progressively built since 1998, and now it includes 5000 patients.
The sampling was reasoned. It was a consecutive recruitment of patients infected by HIV over the period of study and who were meeting the inclusion criteria.
The patients infected by HIV1 under ART, were inchuded in the study and had given their consent.
Data-collection: The following data were collected in included patients: • Cardiovascular risk factors (age, obesity, tobacco, oral contraception) • Parameters related to HIV infection (date of seropositivity discovery, AIDS stage, nadir CD4, CD4 rate , viral load in the 3 previous months, the current ART) • Two measurements in consultation of the blood pressure in sitting position after 10 minutes of rest, • And of an electrocardiogram of surface of rest 12 derivations allowing the study of the rate/rhythm, conduction and the repolarization.
The following definitions were used: • Ischaemia under epicardic was defined by the presence of concordant negative T waves in a coronary territory.
• The under endocardic lesion was defined by significant under shift of the ST segment (> 1,5mm) concordant with a coronary territory.
• The after-effect of necrosis was defined by an abrasion of the concordant waves R in a coronary territory and/or a wave Q broad (≥4/100 second) and deep (≥1/10 second).
• Left ventricular hypertrophy (LVH) was defined by an index of Sokolov-Lyon ≥ 35mm • The lengthening of QT space was defined by a QT calculated according to the formula of Bazett of 0,44s Mode of data acquisition: We constituted a team of clinicians (infectiologists and cardiologists) involded in the follow-up of the cohort of these patients in order to collect data during the period of study.
The data were entered in Epidata, and were analyzed with STATA ® 13. The sociodemographic, clinical, biological and electrocardiographic characteristics of the patients were described. The The data were collected with informed patients who gave their written consent. An information form was given to the participants and a consent form was filled out by them. Authorizations were obtained from the persons in charge of the cohort and from the department of medicine before the beginning of the data collection.

Results
One hundred and twenty three HIV1 infected patients were evaluated. The sociodemographic and clinical characteristics of the patients are reported in

Conclusion
This study on the HIV infected patients under ART, highlighted that asymptomatic myocardic ischemia is frequent. It would be advisable to reinforce its diagnosis by more powerful tests of ischemia for a better specification of its seriousness in order to bring a response in terms of prevention and treatment in this target population with an increased cardiovascular risk.

Ethics
The data were collected with informed patients who gave their written consent. An information form was given to the participants and a consent form was filled out by them. Authorizations were obtained from the persons in charge of the cohort and from the department of medicine before the beginning of the data collection. NNRTI: non-nucleotide reverse transcriptase inhibitor.