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Original Research Paper Mandina Ndona Madone Medicine Longo VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Original Research Paper Medicine CLIMATE CHANGE, POLLUTION, TROPICAL SEASON, HIV-POSITIVE, HIV- NEGATIVE AND HIGH FREQUENCY OF HYPOVITAMINOSIS D IN PATIENTS FROM KINSHASA, DRC Mandina Ndona Department Of Internal Medicine, Faculty Of Medicine, Kinshasa University, Madone Kinshasa, Democratic Republic Of Congo (DRC). Department Of Internal Medicine, Faculty Of Medicine, Kinshasa University, Kinshasa, Democratic Republic Of Congo (DRC). Department of Internal Medicine, Cardiology and Physiopathology Service, University Clinics in Longo-mbenza Kinshasa, Faculty of Medicine, University of Kinshasa; Faculty of Health Benjamin* Sciences, Walter Sisulu University, Mthatha, Private Bag XI, Mthatha 5117, Eastern Cape, South Africa. Biostatistics Unit, Lomo Medical Center and Heart of Africa Center of Cardiology, Lomo University Of Research DR Congo * Corresponding Author School Of Social Sciences And Psychology, Western Sydney University, Renzaho Andre Australia Lepira Mbompeka Department of Internal Medicine, Faculty of Medicine, Kinshasa University, François Kinshasa, Democratic Republic of Congo (DRC). Biostatistics Unit, Lomo Medical Center and Heart of Africa Center of Makulo Rissassi Jr Cardiology, LOMO UNIVERSITY OF RESEARCH DR Congo Wumba-di-mosi Department Of Tropical Medicine, Infectious Diseases And Parasitaries, Parasitology Service, University Clinics In Kinshasa, Faculty Of Medicine, Roger University of Kinshasa; DR Congo Ngatu Roger International University Of Health And Welfare, Japan Department Of Internal Medicine, Cardiology And Physiopathology Apalata Teke Service, University Clinics In Kinshasa, Faculty Of Medicine, University Of Ruphin Kinshasa; Faculty Of Health Sciences, Walter Sisulu University, Mthatha, Private Bag XI, Mthatha 5117, Eastern Cape, South Africa. Mambueni Thamba Department Of Internal Medicine, Faculty Of Medicine, Kinshasa University, Christophe Kinshasa, Democratic Republic Of Congo (DRC). Mbula Mambimbi Department Of Internal Medicine, Faculty Of Medicine, Kinshasa University, Marcel Kinshasa, Democratic Republic Of Congo (DRC). Situakibanza Department Of Internal Medicine, Faculty Of Medicine, Kinshasa University, Nanituma Hippolyte Kinshasa, Democratic Republic Of Congo (DRC). ABSTRACT Background: The main source of vitamin D from the human skin and synthetized by violets B rays emitted by the sun. Environmental factors such us season, climate change, diets, and pollution, are therefore likely to inuence the levels on vitamin D. Furthermore, High frequency of vitamin D deciency is now observed among HIV- infected patients. There is no published data about HIV and Vitamin D despite few scientic articles on HIV and vitamin D status reported by other African countries. Objective: This study sought to determine specically increased prevalence of vitamin D deciency and environmental factors associated with HIV-positive compared to HIV-negative. Methods: Patients followed in Kinshasa hospitals, DRC, where evaluated between the October 2015 and November 2017 period. Serum levels of vitamin D were measured in adult HIV-positives and HIV-negatives during the dry season and the rainy season in the context of climate change and pollution of the megacity of Kinshasa. Results: Five hundred and six patients were enrolled. The prevalence of moderate (≤29 and ≥20 ng/mL) and severe (<20 ng/mL) 25-OH vitamin D deciency was12% (n=64) and 54,6% (n=273) respectively, 34,4 %had normal status. 62,4% (n=316) and 4,2% (n= 21) of patients with deciency (<30 ng/ml) 25-OH vitamin D were HIV-positive and HIV-negative respectively. Water pollution, air pollution, dry season, and cold season La Niña we resignicantly associated with 25-OH vitamin D deciency (P < 0.0001 and <0,05, respectively). Conclusion: Overall, vitamin D deciency was very high whereas vitamin D deciency was epidemic among HIV-positives in comparison with HIV-negatives. Dry season and La Niña season /climate change-variability related to ultraviolet light and oxidative stress-ecotoxicity related pollution might be considered in the prevention and the treatment of HIV-infection in Kinshasa, DRC, Central Africa. KEYWORDS : Vitamin D, HIV infection, dry season, La Niña, climate change, DRC, Central Africa Submitted : 20th July, 2019 Revised : 25th July, 2019 Accepted : 27th August, 2019 Publication : 15th October, 2019 68 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra INTRODUCTION selected by simple random random draw (Centre Hospitalier Despite being closer to the equator with adequate Ultraviolet Boyambi, Hôpital central de la Police Nationale Congolaise, (UV) radiation, developing countries like those of sub- Centre Bomoi de N'djili, Centre Hospitalier Kimbanguiste, Saharan Africa are facing high prevalence of vitamin D Hôpital Général de Makala, Centre Médical de Kinshasa, disorders [1,2]. In sub-Saharan African countries, the Hôpital Général de N'djili, Cliniques Universitaires de prevalence of vitamin D disorders is estimated to be of 30% Kinshasa). and associated with high morbidity and mortality [3,4]. Indeed, in addition to be directly involved in bone disorders, Study population and sampling there is growing evidence supporting the association of The study population consisted in HIV-infected and non- Vitamin D (Vit D) disorders with diseases not related to bones, infected patients taken care in the ART Centers selected for the such as cardiovascular diseases (CVD) [1,2,5]. Therefore, study that met the following inclusion criteria: attending one of early identication and control of Vitamin D disorders among selected ARV care centers, age ≥15 years, known and at high risk groups such as people living with human conrmed HIV-positive or negative serologic status, ARV naïve immunodeciency virus (HIV), could help reducing Vit D or treated (≥2 weeks), informed signed consent. disorders-associated high morbidity and mortality [1,2,6]. Indeed, based on a large number of epidemiological studies The criteria for exclusion were as follows: treatment with using different Vit D thresholds, a recent review article showed vitamin D supplementation or for osteoporosis, complications that the prevalence of Vit D deciency in HIV-infected patients associated with vitamin D deciency/insufciency, such as ranges from 70% to 85% [7,8]. Non-HIV related factors, such as recent hospitalization, chronic renal failure, nephrotic limited sunlight exposure as well as HIV-related ones, such as syndrome, pancreatic failure, chronic liver disease, active chronic inammation, comorbidities, antiretroviral therapy hepatitis or cirrhosis, malabsorptive disorders, active are associated with vitamin D deciency in persons living with malignancy, recent use (previous 3 months) of medications HIV (PLWHIVs) [7,8]. HIV related Vit D deciency has been that alter vitamin D status (carbamazepine, systemic found to negatively impact on disease acquisition, glucocorticoids, hormones, isoniazid, phenobarbital, progression, response to therapy and outcomes [9,10]. phenytoin, or rifampicin) Vitamin D deciency might also interfere with immune restoration following highly active antiretroviral therapy DATA COLLECTION (HAART) and exacerbate HIV-related disease complications Data collection was based on interview, analysis of the in PLWHIV from Sub-Saharan Africa [11]. Therefore, early medical records, physical and laboratory examination. identication of the burden of Vit D disorders and control of During the interview, data were collected on demographic associated risk factors could help improving outcomes in HIV- characteristics (gender, age), socioeconomic status (SES, infected patients, mainly in Sub-Saharan Africa where the burden of both HIV-infection and Vit D disorders are very high marital status, education, religion), social habits (current [1,2]. In the Democratic Republic of the Congo (DRC), Vit D alcohol intake or smoking habit, physical activity), occurrence concentrations were compared between different groups from of opportunistic diseases, chronic diseases not related to HIV Kinshasa without Vit D disorders in the general population (arterial hypertension and/or diabetes), use or antiretroviral [12]. However, there is evidence on signicant association therapy (ART) in the previous three months. between uterine leiomyoma [13], breast cancer (data not published) [14 Osongo], diabetic retinopathy [15], asthma in LABORATORY DATA adult [16], and Vit D deciency. HIV rapid serological test (Alere Determine™ HIV-1/2, Abbott) was used in all participants to conrm the presence of HIV Moreover, available data from certain Sub-Saharan Africa specic antibodies. Determine test is one of the three HIV-tests have yielded conicting results regarding the association of used at rst-line for HIV/AIDS screening in DRC [17]. Vit D disorders and HIV-infection. It is not yet published on Vit D and HIV-infection in DRC. Therefore, the objective of the Total 25-OH Vitamin D (D2 and D3) was measured by the present study was to assess the burden of Vit D disorders ELISA (Enzyme Linked Immunosorbent Assay) method, which associated with demographic HIV and non-HIV related risk is an enzymatic colorimetric assay [18]. factors, particularly environmental factors among naive and treated HIV-infected patients in Kinshasa, the capital City. OPERATIONAL DEFINITIONS The level of Kinshasa urbanization (Figure 1) were dened MATERIALS AND METHODS according
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