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Amutuhaire W, Semitala FC, Kimera ID, Namugenyi C, Mulindwa F, Ssenyonjo R, Katwesigye R, Mugabe F, Mutungi G, Ssinabulya I, Schwartz JI, Katahoire AR, Musoke LS, Yendewa GA, Longenecker CT, Muddu M. Time to blood pressure control and predictors among patients receiving integrated treatment for hypertension and HIV based on an adapted WHO HEARTS implementation strategy at a large urban HIV clinic in Uganda. J Hum Hypertens 2024; 38:452-459. [PMID: 38302611 PMCID: PMC11076202 DOI: 10.1038/s41371-024-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/01/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
In this cohort study, we determined time to blood pressure (BP) control and its predictors among hypertensive PLHIV enrolled in integrated hypertension-HIV care based on the World Health Organization (WHO) HEARTS strategy at Mulago Immunosuppression Clinic in Uganda. From August 2019 to March 2020, we enrolled hypertensive PLHIV aged ≥ 18 years and initiated Amlodipine 5 mg mono-therapy for BP (140-159)/(90-99) mmHg or Amlodipine 5 mg/Valsartan 80 mg duo-therapy for BP ≥ 160/90 mmHg. Patients were followed with a treatment escalation plan until BP control, defined as BP < 140/90 mmHg. We used Cox proportional hazards models to identify predictors of time to BP control. Of 877 PLHIV enrolled (mean age 50.4 years, 62.1% female), 30% received mono-therapy and 70% received duo-therapy. In the monotherapy group, 66%, 88% and 96% attained BP control in the first, second and third months, respectively. For patients on duo-therapy, 56%, 83%, 88% and 90% achieved BP control in the first, second, third, and fourth months, respectively. In adjusted Cox proportional hazard analysis, higher systolic BP (aHR 0.995, 95% CI 0.989-0.999) and baseline ART tenofovir/lamivudine/efavirenz (aHR 0.764, 95% CI 0.637-0.917) were associated with longer time to BP control, while being on ART for >10 years was associated with a shorter time to BP control (aHR 1.456, 95% CI 1.126-1.883). The WHO HEARTS strategy was effective at achieving timely BP control among PLHIV. Additionally, monotherapy anti-hypertensive treatment for stage I hypertension is a viable option to achieve BP control and limit pill burden in resource limited HIV care settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | | | | | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | | | - Frank Mugabe
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | - Gerald Mutungi
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | | | - Jeremy I Schwartz
- Yale School of Medicine, Section of General Internal Medicine, Connecticut, CT, USA
| | - Anne R Katahoire
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lewis S Musoke
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chris T Longenecker
- Department of Global Health and Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Martin Muddu
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
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Punjabi NM, Brown TT, Abreu AR, Aurora RN, Patel SR, Stosor V, Cho JHJ, D’Souza G, Wallace D, Margolick JB. Sleep-Disordered Breathing and Prevalent Hypertension in Men With and Without HIV. J Acquir Immune Defic Syndr 2023; 94:349-354. [PMID: 37643405 PMCID: PMC10824508 DOI: 10.1097/qai.0000000000003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a known risk factor for hypertension. Despite the well-established link between HIV infection and hypertension, it remains to be determined whether HIV infection modifies the association between SDB and hypertension. SETTING The Multicenter AIDS Cohort Study. METHODS SDB was assessed using in-home polysomnography in 779 men (436 with and 343 without HIV). The apnea-hypopnea index (AHI) based on oxyhemoglobin desaturation threshold of ≥3% or arousal (AHI 3a ) and ≥4% (AHI 4 ) along with oxygen desaturation index (ODI) were used to quantify SDB severity. Hypertension was defined as a blood pressure ≥140/90 mm Hg, use of antihypertensive medication, or self-report of a clinical diagnosis. The associations between HIV, SDB, and hypertension were characterized using multivariable logistic regression. RESULTS The prevalence of hypertension and SDB (AHI 3a ≥ 5 events/hr) was high, with estimates of 53.8% and 82.8%, respectively. Among men without SDB, HIV was independently associated with hypertension, with an adjusted odds ratio (OR) of 3.05 [95% confidence interval (CI): 1.33 to 7.01]. In men without HIV, SDB was associated with hypertension (OR: 2.93; 95% CI: 1.46 to 5.86). No significant increase in the odds of hypertension was noted in men with both HIV and SDB compared with men with either factor alone, with an OR of 3.24 (95% CI: 1.62 to 6.47). These results were consistent across different measures used to define SDB (AHI 3a , AHI 4 , ODI 3 , and ODI 4 ). CONCLUSIONS Predictors of hypertension differed by HIV status. SDB was associated with hypertension in men without HIV, but not in men with HIV. Among men with HIV, SDB did not affect the odds of hypertension.
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Drago F, Soshnik-Schierling L, Cabling ML, Pattarabanjird T, Desderius B, Nyanza E, Raymond H, McNamara CA, Peck RN, Shiau S. Characterizing blood pressure trajectories in people living with HIV following antiretroviral therapy: A systematic review. HIV Med 2023; 24:1106-1114. [PMID: 37474730 PMCID: PMC10799172 DOI: 10.1111/hiv.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The advent of antiretroviral therapy (ART) has reduced AIDS-related morbidity and mortality among people living with HIV (PLWH). Due to increased survival, PLWH have now been found to be at risk of chronic conditions related to ageing, such as cardiovascular disease (CVD). Hypertension is common in PLWH and is a major risk factor for the development of CVD. We conducted a systematic literature review to evaluate the research evidence on longitudinal blood pressure (BP) trajectories following ART initiation in PLWH. METHODS We searched the following databases: PubMed, CINHAL, Scopus, and Web of Science (up to 15 March 2021) for peer-reviewed published studies that reported BP trajectories following ART initiation in PLWH. Three reviewers independently screened all studies by title and abstract. We included articles in English, published up to March 2021, that report office BP trajectories in PLWH initiating ART. A total of 10 publications met our inclusion criteria. Eight studies were prospective cohorts and two were retrospective. RESULTS Nine out of 10 studies in the literature reported an increase in systolic BP (4.7-10.0 mmHg in studies with a follow-up range of 6 months to 8 years, and 3.0-4.7 mmHg/year in time-averaged studies). In addition, four out of 10 studies reported increases in diastolic BP (2.3-8.0 mmHg for a 6 month to 6.8-year follow-up range and 2.3 mmHg/year). CONCLUSION Systolic BP consistently increases while diastolic BP changes are more heterogeneous following ART initiation in PLWH. However, the studies were highly variable with respect to population demographics, ART regimen and duration, and follow-up time. Nevertheless, given the risks of CVD complications, such as stroke, heart failure and myocardial infarction, associated with elevated BP, results highlight the importance of future research in this area. It will be important to better characterize BP trajectories over time, identify the most critical times for interventions to reduce BP, determine the long-term CVD consequences in PLWH with elevated BP, and understand how different ART regimens may or may not influence BP and CVD disease.
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Affiliation(s)
- Fabrizio Drago
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | | | - Mark L. Cabling
- Department of English, Communication, and Society, King’s College London, London, United Kingdom
| | - Tanyaporn Pattarabanjird
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Bernard Desderius
- School of medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Elias Nyanza
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando, Mwanza, Tanzania
| | - Henry Raymond
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Coleen A. McNamara
- Carter Immunology Center, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Robert N. Peck
- Center for Global Health, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, United State
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
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Tegegne KD, Adela GA, Kassie GA, Mengstie MA, Seid MA, Zemene MA, Feleke SF, Dejenie TA, Abebe EC, Anley DT, Dessie AM, Gesese MM, Yimer N, Gebeyehu NA. Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis. BMC Infect Dis 2023; 23:724. [PMID: 37880643 PMCID: PMC10601241 DOI: 10.1186/s12879-023-08679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND In recent years, improved access to effective antiretroviral therapy has meant that people living with human immune virus are living longer than before. The burden of non-communicable diseases particularly, hypertension parallels with the increase in age. Although hypertension screening is thought to be an effective indicator of overall health status and paves the way for early interventions in peoples living with human immune virus, the exact prevalence of hypertension in this population remained unknown. We aimed to report the prevalence of hypertension and examine the factors associated with hypertension among people living with human immune virus in East Africa. METHODS In this systematic review and meta-analysis, we searched PubMed, Science Direct, Scopus, Cochrane library, and Google Scholar databases for studies published until January 1, 2023. The search period was from January 10/2023, to February 10/ 2023. Random-effect models were used to calculate the pooled prevalence of hypertension. Subgroup analyses were conducted to explore potential heterogeneity. The Funnel plot and Egger's test were used to assess publication bias. RESULT A total of 15 studies with 10,916 individuals were included in the present meta-analysis. The pooled prevalence of hypertension among people living with human immune virus was19.75% (95% CI, 16.07%-23.42%)),). The prevalence of hypertension was not differed between studies conducted 2014- 2019 and, studies conducted 2020-2022. The prevalence of hypertension was lowest in Ethiopia (16.13%) and highest in Tanzania (26.76%). Alcohol consumption (Adjusted Odds Ratio (AOR): 3.39, 95% CI: 2.35-4.43), diabetes (AOR: 2.64, 95% CI: 1.89-3.39), longer duration of HIV (AOR: 1.72, 95% CI: 1.15-2.3), male sex (AOR: 1.62, 95% CI: 1.43-1.8), obesity (AOR: 2.89, 95% CI: 1.94-3.84), and older age (AOR: 2.25, 95% CI: 2.0-2.5), were the factors associated with the presence of hypertension in people living with human immune virus. CONCLUSION Our study shows that one in five peoples living with human immune virus have hypertension causing symptoms and impairment, therefore requiring treatment. Designing effective health screening and hypertension management intervention programs helps to prevent the occurrence of hypertension and promotes peoples' overall quality of life.
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Affiliation(s)
- Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Getachew Asmare Adela
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajaw Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Health Science, Gondar University, Gondar, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalign Melese Gesese
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Nega Yimer
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
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Byonanebye DM, Polizzotto MN, Neesgaard B, Sarcletti M, Matulionyte R, Braun DL, Castagna A, de Wit S, Wit F, Fontas E, Vehreschild J, Vesterbacka J, Greenberg L, Hatleberg C, Garges H, Gallant J, Volny Anne A, Öllinger A, Mozer‐Lisewska I, Surial B, Spagnuolo V, Necsoi C, van der Valk M, Mocroft A, Law M, Ryom L, Petoumenos K. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Med 2022; 23:895-910. [PMID: 35233903 PMCID: PMC9545382 DOI: 10.1111/hiv.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. METHODS Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. RESULTS Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. CONCLUSION Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND.
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Affiliation(s)
- Dathan M. Byonanebye
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia,School of Public HealthMakerere UniversityKampalaUganda
| | - Mark N. Polizzotto
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bastian Neesgaard
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mario Sarcletti
- Department of Dermatology, Venerology and AllergologyMedical University InnsbruckInnsbruckAustria
| | - Raimonda Matulionyte
- Department of Infectious Diseases and DermatovenerologyFaculty of MedicineVilnius University Hospital Santaros KlinikosVilnius UniversityVilniusLithuania
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital EpidemiologySwitzerland Swiss HIV Cohort Study (SHCS)Institute of Medical VirologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Antonella Castagna
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Stéphane de Wit
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands
| | - Eric Fontas
- Nice HIV CohortUniversité Côte d’Azur et Centre Hospitalier UniversitaireNiceFrance
| | - Jörg Janne Vehreschild
- Medical Department 2Hematology/OncologyUniversity Hospital of FrankfurtFrankfurtGermany,Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
| | - Jan Vesterbacka
- Swedish InfCare HIV CohortKarolinska University HospitalHuddingeSweden
| | - Lauren Greenberg
- Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Camilla Hatleberg
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | | | | | - Angela Öllinger
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | - Bernard Surial
- Department of Infectious Diseases, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Vincenzo Spagnuolo
- San Raffaele Scientific InstituteUniversità Vita‐Salute San RaffaeleMilanoItaly
| | - Coca Necsoi
- CHU Saint PierreInfectious DiseasesUniversité Libre de BruxellesBrusselsBelgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) CohortHIV Monitoring FoundationAmsterdamThe Netherlands,Division of Infectious DiseasesDepartment of Internal MedicineAmsterdam Institute for Infection and ImmunityAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Amanda Mocroft
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark,Centre for Clinical ResearchEpidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Matthew Law
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lene Ryom
- CHIPCentre of Excellence for Health, Immunity, and InfectionsRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kathy Petoumenos
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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Ghazi L, Baker JV, Sharma S, Jain MK, Palfreeman A, Necsoi C, Murray DD, Neaton JD, Drawz PE. Role of Inflammatory Biomarkers in the Prevalence and Incidence of Hypertension Among HIV-Positive Participants in the START Trial. Am J Hypertens 2020; 33:43-52. [PMID: 31800000 DOI: 10.1093/ajh/hpz132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/03/2019] [Accepted: 08/08/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The association between hypertension (HTN) and inflammatory biomarkers (interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hsCRP]) in HIV-positive persons with CD4+ count >500 cells/mm3 is unknown. METHODS We studied HTN in participants of the Strategic Timing of AntiRetroviral Treatment (START) trial of immediate vs. deferred antiretroviral therapy (ART) in HIV-positive, ART naive adults with CD4+ count > 500 cells/mm3. HTN was defined as having a systolic blood pressure (BP) ≥140 mmHg, a diastolic BP ≥90 mmHg, or using BP-lowering therapy. Logistic and discrete Cox regression models were used to study the association between baseline biomarker levels with prevalent and incident HTN. RESULTS Among 4,249 participants with no history of cardiovascular disease, the median age was 36 years, 55% were nonwhite, and the prevalence of HTN at baseline was 18.9%. After adjustment for race, age, gender, body mass index (BMI), diabetes, smoking, HIV RNA and CD4+ levels, associations of IL-6 and hsCRP with HTN prevalence were not significant (OR per twofold higher:1.10, 95% confidence interval [CI]: 0.99, 1.20 for IL-6 and 1.05, 95% CI: 0.99, 1.10 for hsCRP). Overall incidence of HTN was 6.8 cases/100 person years. In similarly adjusted models, neither IL-6 (Hazard ratios [HR] per twofold higher IL-6 levels: 0.97, 95% CI: 0.88, 1.08) nor hsCRP (HR per twofold higher hsCRP levels: 0.97, 95% CI: 0.92, 1.02) were associated with risk of incident HTN. Associations did not differ by treatment group. Age, race, gender, and BMI were significantly associated with both the prevalence and incidence of HTN. CONCLUSIONS Traditional risk factors and not baseline levels of IL-6 or hsCRP were associated with the prevalence and incidence of HTN in START.
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Affiliation(s)
- Lama Ghazi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason V Baker
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mamta K Jain
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Adrian Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Coca Necsoi
- Service des Maladies Infectieuses, CHU St-Pierre, ULB, Bruxelles, Belgium
| | - Daniel D Murray
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul E Drawz
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Muller EV, Gimeno SGA. Risk factors for cardiovascular disease in HIV/AIDS patients treated with highly active antiretroviral therapy (HAART) in the central-southern region of the state of Paraná - Brazil. CIENCIA & SAUDE COLETIVA 2019; 24:1903-1914. [PMID: 31166523 DOI: 10.1590/1413-81232018245.16682017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/30/2017] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to describe metabolic changes in HIV/AIDS patients according to the treatment regimen. It was a retrospective cohort conducted from 2002 to 2014. Researchers surveyed clinical variables and treatment regimen of 538 individuals. They used measures of central tendency and marginal logistic regression to determine the influence of the treatment regimen on clinical variables over time; survival was estimated using Kaplan-Meier curves. 56.2% of patients were male, 82.2% white, 33.8% had 4 to 7 years of study, 49.2% were married, 98.5% had sexual transmission, and 89.0% were heterosexuals. During the study period, 24.4% had hypertension, 18.2% changed cholesterol, 39.7% low HDL, 51.3% high triglycerides and 33.3% hyperglycemia. Treatment regimens with nucleotide reverse transcriptase inhibitors associated with protease inhibitors, and the association of different classes of antiretrovirals have been associated with greater lipid changes. Higher metabolic changes were observed in patients with longer treatment time. It is concluded that preventive measures, as well as early treatment, can contribute to minimize the risks of developing cardiovascular diseases.
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Affiliation(s)
- Erildo Vicente Muller
- Universidade Estadual de Ponta Grossa. Av. General Carlos Cavalcanti 4.748, Uvaranas. 84030-900 Ponta Grossa PR Brasil.
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Brennan AT, Jamieson L, Crowther NJ, Fox MP, George JA, Berry KM, Stokes A, Maskew M, Sanne I, Long L, Cassim N, Rosen S. Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa. PLoS One 2018; 13:e0204020. [PMID: 30281618 PMCID: PMC6169897 DOI: 10.1371/journal.pone.0204020] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/01/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort. METHODS We conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004-2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk. RESULTS Among 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3-5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3. CONCLUSION Over 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.
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Affiliation(s)
- Alana T. Brennan
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | - Matthew P. Fox
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Jaya A. George
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | - Kaitlyn M. Berry
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian Sanne
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care, Johannesburg, South Africa
| | - Lawrence Long
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naseem Cassim
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hatleberg CI, Ryom DRL, Monforte AD, Fontas E, Reiss P, Kirk O, Sadr WE, Phillips A, de Wit S, Dabis F, Weber R, Law M, Lundgren JD, Sabin C. Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. HIV Med 2018; 19:605-618. [PMID: 30019813 PMCID: PMC6169998 DOI: 10.1111/hiv.12639] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Previous studies have suggested that hypertension in HIV-positive individuals is associated primarily with traditional risk factors such as older age, diabetes and dyslipidaemia. However, controversy remains as to whether exposure to antiretroviral (ARV) drugs poses additional risk, and we investigated this question in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort. METHODS The incidence of hypertension [systolic blood pressure (BP) > 140 and/or diastolic BP > 90 mmHg and/or initiation of antihypertensive treatment] was determined overall and in strata defined by demographic, metabolic and HIV-related factors, including cumulative exposure to each individual ARV drug. Predictors of hypertension were identified using uni- and multivariable Poisson regression models. RESULTS Of 33 278 included persons, 7636 (22.9%) developed hypertension over 223 149 person-years (PY) [incidence rate: 3.42 (95% confidence interval (CI) 3.35-3.50) per 100 PY]. In univariable analyses, cumulative exposure to most ARV drugs was associated with an increased risk of hypertension. After adjustment for demographic, metabolic and HIV-related factors, only associations for nevirapine [rate ratio 1.07 (95% CI: 1.04-1.13) per 5 years] and indinavir/ritonavir [rate ratio 1.12 (95% CI: 1.04-1.20) per 5 years] remained statistically significant, although effects were small. The strongest independent predictors of hypertension were male gender, older age, black African ethnicity, diabetes, dyslipidaemia, use of lipid-lowering drugs, high body mass index (BMI), renal impairment and a low CD4 count. CONCLUSIONS We did not find evidence for any strong independent association between exposure to any of the individual ARV drugs and the risk of hypertension. Findings provide reassurance that screening policies and preventative measures for hypertension in HIV-positive persons should follow algorithms used for the general population.
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Affiliation(s)
- Camilla Ingrid Hatleberg
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - DR Lene Ryom
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antonella d’Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Eric Fontas
- Dept. of Public Health, Nice University Hospital, Nice, France
| | - Peter Reiss
- Academic Medical Center, Dept. of Global Health and Div. of Infectious Diseases, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Ole Kirk
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wafaa El- Sadr
- ICAP-Columbia University and Harlem Hospital, New York, USA
| | - Andrew Phillips
- Research Dept. of Infection and Population Health, UCL, London, United Kingdom
| | - Stephane de Wit
- Div. of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Francois Dabis
- CHU de Bordeaux and INSERM U897, Université de Bordeaux, Talence, France
| | - Rainer Weber
- Division of infectious diseases and hospital epidemiology, University hospital Zurich, University of Zurich, Switzerland
| | - Matthew Law
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Jens Dilling Lundgren
- CHIP, Dept. of Infectious Diseases Section 2100, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Sabin
- Research Dept. of Infection and Population Health, UCL, London, United Kingdom
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10
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Affiliation(s)
- Sasha A Fahme
- From the Center for Global Health, Weill Cornell Medical College, New York, NY (S.A.F., R.P.)
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania (S.A.F., R.P.)
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (G.S.B.)
| | - Robert Peck
- From the Center for Global Health, Weill Cornell Medical College, New York, NY (S.A.F., R.P.)
- Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania (S.A.F., R.P.)
- Mwanza Interventions Trial Unit, Tanzania (R.P.)
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11
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Batavia AS, Severe P, Lee MH, Apollon A, Zhu YS, Dupnik KM, McNairy ML, Pape JW, Fitzgerald DW, Peck RN. Blood pressure and mortality in a prospective cohort of HIV-infected adults in Port-au-Prince, Haiti. J Hypertens 2018; 36:1533-1539. [PMID: 29634661 PMCID: PMC5976542 DOI: 10.1097/hjh.0000000000001723] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine how baseline blood pressure and incident hypertension related to antiretroviral therapy (ART) initiation, HIV-related inflammation and mortality in HIV-infected adults in a low-income country. METHODS We conducted long-term follow-up of HIV-infected adults who had participated in a trial of early vs. delayed initiation of ART in Port-au-Prince, Haiti. Between 2005 and 2008, 816 HIV-infected adults were randomized to early (N = 408) vs. delayed ART (when CD4 cell count <200 cells/μl or AIDS-defining condition; N = 408). Blood pressure was measured every 3 months. Hypertension was diagnosed according to the Joint National Committee (JNC-7) guidelines. Biomarkers of inflammation and coagulation were measured from banked enrolment plasma samples. Survival analyses were performed using Stata 14. RESULTS The median age at enrolment was 39 years. The median follow-up time was 7.3 years. The hypertension incidence rate was 3.41 per 100 person-years, and was similar in early and delayed ART groups. In multivariable models, independent predictors of incident hypertension were older age, higher BMI and plasma interleukin (IL)-6 levels (adjusted hazard ratio, aHR = 1.23, P < 0.001). Systolic pressure more than 140 mmHg at enrolment was associated with increased mortality (aHR = 2.47, P = 0.03) as was systolic pressure less than 90 mmHg (aHR = 2.25, P = 0.04). Prevalent and incident hypertension were also significantly associated with mortality. CONCLUSION In a large prospective study of HIV-infected adults, we found a high incidence of hypertension associated with HIV-related inflammation. Baseline hypertension conferred a more than two-fold increased risk of death. Among HIV-infected adults in low-income countries, hypertension should be considered a serious threat to long-term survival.
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Affiliation(s)
- Ashita S Batavia
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
| | - Patrice Severe
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Myung Hee Lee
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
| | - Alexandra Apollon
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Yuan Shan Zhu
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
| | - Kathryn M Dupnik
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
| | | | - Jean W Pape
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | | | - Robert N Peck
- Weill Cornell Medicine, Department of Medicine, New York, New York, USA
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12
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Abstract
PURPOSE OF REVIEW This review describes what is known concerning the burden of hypertension among people living with HIV (PLHIV), and also addresses relevant topics with respect to its risk factors and clinical management. RECENT FINDINGS Hypertension is highly prevalent in HIV-positive populations, and may be more common than in HIV-negative populations. Risk factors contributing to the development of hypertension in PLHIV include demographic factors, genetic predisposition, lifestyle, comorbidities such as obesity, antiretroviral therapy-related changes in body composition, and potentially also immunodeficiency, immune activation and inflammation, as well as effects from antiretroviral therapy itself. Clinical management of hypertension in PLHIV requires awareness for drug-drug interactions between antiretroviral drugs and antihypertensive drugs. Awareness, treatment, and control of hypertension in PLHIV is currently suboptimal and should be improved. SUMMARY The burden of hypertension among PLHIV is high and its pathophysiology most likely multifactorial. Elucidating the exact pathophysiology of hypertension in PLHIV is vital as this may provide new targets to impact and improve clinical management. In the meantime, efforts should be made to improve hypertension management as per existing clinical guidelines in order to safeguard cardiovascular health and quality of life in PLHIV.
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13
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Isa SE, Kang'ombe AR, Simji GS, Shehu NY, Oche AO, Idoko JA, Cuevas LE, Gill GV. Hypertension in treated and untreated patients with HIV: a study from 2011 to 2013 at the Jos University Teaching Hospital, Nigeria. Trans R Soc Trop Med Hyg 2018; 111:172-177. [PMID: 28673018 DOI: 10.1093/trstmh/trx030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/30/2017] [Indexed: 01/09/2023] Open
Abstract
Background Individuals with HIV, especially those on antiretroviral therapy (ART), may have increased risk of hypertension. We investigated the prevalence of hypertension at enrolment and 12 months after commencing ART in a Nigerian HIV clinic. Methods Data from patients enrolled for ART from 2011 to 2013 were analysed, including 2310 patients at enrolment and 1524 re-evaluated after 12 months of ART. The presence of hypertension, demographic, clinical and biochemical data were retrieved from standardized databases. Bivariate and logistic regressions were used to identify baseline risk factors for hypertension. Results Prevalence of hypertension at enrolment was 19.3% (95% CI 17.6-20.9%), and age (p<0.001), male sex (p=0.004) and body mass index (BMI) (p<0.001) were independent risk factors for hypertension. Twelve months after initiating ART, a further 31% (95% CI 17.6-20.9%) had developed hypertension. Total prevalence at that point was 50.2%. Hypertension among those on ART was associated with age (p=0.009) and BMI (p=0.008), but not with sex. There were no independently significant associations between hypertension and CD4+ counts, viral load or type of ART. Conclusions Hypertension is common in HIV infected individuals attending the HIV clinic. Patients initiating ART have a high risk of developing hypertension in the first year of ART. Since BMI is modifiable, life-style advice aimed at weight reduction is strongly advisable.
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Affiliation(s)
- Samson E Isa
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Nigeria.,APIN Clinic, Jos University Teaching Hospital, Nigeria
| | - Arthur R Kang'ombe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gomerep S Simji
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Nigeria.,APIN Clinic, Jos University Teaching Hospital, Nigeria
| | - Nathan Y Shehu
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Nigeria.,APIN Clinic, Jos University Teaching Hospital, Nigeria
| | - Agbaji O Oche
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Nigeria.,APIN Clinic, Jos University Teaching Hospital, Nigeria
| | - John A Idoko
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Nigeria.,National Agency for the Control of AIDS, Abuja Nigeria
| | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Geoffrey V Gill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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14
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Olaiya O, Weiser J, Zhou W, Patel P, Bradley H. Hypertension Among Persons Living With HIV in Medical Care in the United States-Medical Monitoring Project, 2013-2014. Open Forum Infect Dis 2018; 5:ofy028. [PMID: 29516021 PMCID: PMC5833317 DOI: 10.1093/ofid/ofy028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/29/2018] [Indexed: 11/14/2022] Open
Abstract
Hypertension is a leading modifiable risk factor for cardiovascular disease (CVD), and persons living with HIV are at increased risk for both hypertension and CVD. Therefore, using data from a nationally representative sample of patients living with HIV, we assessed missed opportunities for the optimal management of hypertension.
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Affiliation(s)
| | - John Weiser
- Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Wen Zhou
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Time trend in hypertension prevalence, awareness, treatment, and control in a contemporary cohort of HIV-infected patients: the HIV and Hypertension Study. J Hypertens 2017; 35:409-416. [PMID: 28005710 DOI: 10.1097/hjh.0000000000001150] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypertension control is often inadequate in HIV patients. In a contemporary, nationwide cohort of Italian HIV-infected adults, we assessed time trends in hypertension prevalence, awareness, treatment, and control. We also evaluated predictors of cardiovascular events and of new-onset hypertension. METHODS Multicenter prospective cohort study, sampling 961 consecutive HIV patients (71% men, mean age 46 ± 9 years, 30% hypertensive) examined in 2010-2014 and after a median follow-up of 3.4 years. RESULTS Among hypertensive patients, hypertension awareness (63% at baseline and 92% at follow-up), treatment (54 vs. 79%), and control (35 vs. 59%) all improved during follow-up. The incidence of new-onset hypertension was 50.1/1000 person-years (95% confidence interval, 41.2-60.3). Multivariable-adjusted predictors of hypertension were age, BMI, estimated cardiovascular risk, blood pressure, and advanced HIV clinical stage.In total, 35 new cardiovascular events were reported during follow-up (11.1/1000 person-years). In a multivariate model, baseline cardiovascular risk and hypertensive status predicted incident cardiovascular events, whereas a higher CD4 cell count had a protective role. In treated hypertensive patients, the use of integrase strand transfer inhibitors at follow-up was associated with a lower SBP (average yearly change, -3.8 ± 1.6 vs. -0.9 ± 0.5 mmHg in integrase strand transfer inhibitor users vs. nonusers, respectively, P = 0.02). CONCLUSION Hypertension awareness, treatment, and control rates all improved in adult Italian HIV patients over the last few years, although hypertension remains highly prevalent (41%) in middle-aged HIV patients, and significantly impacts cardiovascular morbidity. Traditional risk factors and advanced HIV disease predict new-onset hypertension, whereas CD4 cell count favorably affects future cardiovascular events.
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16
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Magande PN, Chirundu D, Gombe NT, Mungati M, Tshimanga M. Determinants of uncontrolled hypertension among clients on anti-retroviral therapy in Kadoma City, Zimbabwe, 2016. Clin Hypertens 2017; 23:14. [PMID: 28690867 PMCID: PMC5496338 DOI: 10.1186/s40885-017-0070-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/28/2017] [Indexed: 12/12/2022] Open
Abstract
Background Clients on anti-retroviral therapy (ART) are living longer and have risk of hypertension. Side effects of medicines and aging increase this risk. Hypertension prevalence among clients on ART in Kadoma City was estimated to be 30% in 2015. Of these, 61% had uncontrolled hypertension. This was high compared to 46% of hypertensives in the general population who had uncontrolled hypertension. We determined factors associated with uncontrolled hypertension among clients on ART. Methods A 1.1 unmatched case control study was conducted. Interviews, anthropometric measurements and record reviews were to collect data on demography and medical history. Epi Info 7 was used for univariate, bivariate analysis and logistic regression. Results One hundred and fifty-two cases and 152 controls were recruited into the study. Adding salt to dishes regularly aOR = 5.69 (3.19–10.16), body mass index (BMI) above 25 kg/m2 aOR = 2.81 (1.60–4.91) and history of elevated blood pressure in previous year aOR = 2.34 (1.33–4.13) were independent risk factors. Independent protective factors were duration more than 2 years since HIV diagnosis aOR = 0.58 (0.35–0.95), duration less than 5 years since hypertension diagnosis aOR = 0.50 (0.30–0.83) and walking or cycling as a means of transport aOR = 0.27 (0.16–0.48). Conclusion Adding salt to dishes regularly, BMI above 25 kg/m2, history of elevated blood pressure in the previous year, duration more than 2 years since HIV diagnosis, duration less than 5 years since hypertension diagnosis and walking or cycling as a means of transport were independently associated with uncontrolled hypertension. Health education on lifestyle changes like walking and cycling as transport and dietary modification such as salt intake reduction were recommended.
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Affiliation(s)
| | | | | | - More Mungati
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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17
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van Amsterdam MA, van Assen S, Sprenger HG, Wilting KR, Stienstra Y, Bierman WFW. Yield of yearly routine physical examination in HIV-1 infected patients is limited: A retrospective cohort study in the Netherlands. PLoS One 2017. [PMID: 28636651 PMCID: PMC5479549 DOI: 10.1371/journal.pone.0179539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Routine physical examinations might be of value in HIV-infected patients, but the yield is unknown. We determined the diagnoses that would have been missed without performing annual routine physical examinations in HIV-infected patients with stable disease. Methods Data were collected from the medical records of 299 HIV-1-infected patients with CD4 count >350 cells/mm3 if not using combination antiretroviral therapy (cART), or CD4 count >100 cells/mm3 and undetectable viral load if using cART. We defined the diagnoses that would have been missed without performing routine physical examinations on annual check-ups in 2010. Exclusion criteria were hepatitis B/C co-infection, start/ switch of cART < 24 weeks, pregnancy, and transgenderism. Results 215 patients (72%) had positive findings: lipodystrophy (30%), lymphadenopathy (16%) and hypertension (8.4%) were the most common. Two-thirds of all findings were not new or were based on complaints indicating a physical examination even if not routinely scheduled. For 24 patients (8.0%) the routine physical examination led to the finding of a new diagnosis: six—all men who have sex with men (MSM)—had a concurrent sexually transmitted infection, eight had hypertension, and ten others had a large variety of diagnoses. A total atrioventricular block with bradycardia was the most clinically relevant finding. Conclusions Annual physical examinations of HIV-infected patients with stable disease brought few new diagnoses that would have been missed without performing a routine examination. Our results suggest that standard assessments could be restricted to six-monthly measuring blood pressure in all patients and annually performing anogenital and digital rectal examination on MSM.
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Affiliation(s)
- Marleen A. van Amsterdam
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sander van Assen
- Department of Internal Medicine, Treant Zorggroep, Emmen, the Netherlands
| | - Herman G. Sprenger
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kasper R. Wilting
- Department of Medical microbiology & Infection control, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ymkje Stienstra
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter F. W. Bierman
- Infectious Diseases Service, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- * E-mail:
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D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda. J Acquir Immune Defic Syndr 2017; 73:396-402. [PMID: 27171743 DOI: 10.1097/qai.0000000000001074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda. METHODS We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. RESULTS In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio. CONCLUSION BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.
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Ludema C, Cole SR, Eron JJ, Holmes GM, Anastos K, Cocohoba J, Cohen MH, Cooper HL, Golub ET, Kassaye S, Konkle-Parker D, Metsch L, Milam J, Wilson TE, Adimora AA. Health Insurance Type and Control of Hypertension Among US Women Living With and Without HIV Infection in the Women's Interagency HIV Study. Am J Hypertens 2017; 30:594-601. [PMID: 28407044 DOI: 10.1093/ajh/hpx015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/18/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health care access is an important determinant of health. We assessed the effect of health insurance status and type on blood pressure control among US women living with (WLWH) and without HIV. METHODS We used longitudinal cohort data from the Women's Interagency HIV Study (WIHS). WIHS participants were included at their first study visit since 2001 with incident uncontrolled blood pressure (BP) (i.e., BP ≥140/90 and at which BP at the prior visit was controlled (i.e., <135/85). We assessed time to regained BP control using inverse Kaplan-Meier curves and Cox proportional hazard models. Confounding and selection bias were accounted for using inverse probability-of-exposure-and-censoring weights. RESULTS Most of the 1,130 WLWH and 422 HIV-uninfected WIHS participants who had an elevated systolic or diastolic measurement were insured via Medicaid, were African-American, and had a yearly income ≤$12,000. Among participants living with HIV, comparing the uninsured to those with Medicaid yielded an 18-month BP control risk difference of 0.16 (95% CI: 0.10, 0.23). This translates into a number-needed-to-treat (or insure) of 6; to reduce the caseload of WLWH with uncontrolled BP by one case, five individuals without insurance would need to be insured via Medicaid. Blood pressure control was similar among WLWH with private insurance and Medicaid. There were no differences observed by health insurance status on 18-month risk of BP control among the HIV-uninfected participants. CONCLUSIONS These results underscore the importance of health insurance for hypertension control-especially for people living with HIV.
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Affiliation(s)
- Christina Ludema
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Stephen R. Cole
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joseph J. Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - G. Mark Holmes
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Marge H. Cohen
- Department of Medicine, Cook County Health and Hospital System, Chicago, Illinois, USA
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Hannah L.F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA
| | - Adaora A. Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Incidence and risk factors for hypertension among HIV patients in rural Tanzania - A prospective cohort study. PLoS One 2017; 12:e0172089. [PMID: 28273105 PMCID: PMC5342176 DOI: 10.1371/journal.pone.0172089] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 01/31/2017] [Indexed: 01/11/2023] Open
Abstract
Introduction Scarce data are available on the epidemiology of hypertension among HIV patients in rural sub-Saharan Africa. We explored the prevalence, incidence and risk factors for incident hypertension among patients who were enrolled in a rural HIV cohort in Tanzania. Methods Prospective longitudinal study including HIV patients enrolled in the Kilombero and Ulanga Antiretroviral Cohort between 2013 and 2015. Non-ART naïve subjects at baseline and pregnant women during follow-up were excluded from the analysis. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg on two consecutive visits. Cox proportional hazards models were used to assess the association of baseline characteristics and incident hypertension. Results Among 955 ART-naïve, eligible subjects, 111 (11.6%) were hypertensive at recruitment. Ten women were excluded due to pregnancy. The remaining 834 individuals contributed 7967 person-months to follow-up (median 231 days, IQR 119–421) and 80 (9.6%) of them developed hypertension during a median follow-up of 144 days from time of enrolment into the cohort [incidence rate 120.0 cases/1000 person-years, 95% confidence interval (CI) 97.2–150.0]. ART was started in 630 (75.5%) patients, with a median follow-up on ART of 7 months (IQR 4–14). Cox regression models identified age [adjusted hazard ratio (aHR) 1.34 per 10 years increase, 95% CI 1.07–1.68, p = 0.010], body mass index (aHR per 5 kg/m2 1.45, 95% CI 1.07–1.99, p = 0.018) and estimated glomerular filtration rate (aHR < 60 versus ≥ 60 ml/min/1.73 m2 3.79, 95% CI 1.60–8.99, p = 0.003) as independent risk factors for hypertension development. Conclusions The prevalence and incidence of hypertension were high in our cohort. Traditional cardiovascular risk factors predicted incident hypertension, but no association was observed with immunological or ART status. These data support the implementation of routine hypertension screening and integrated management into HIV programmes in rural sub-Saharan Africa.
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Ascher SB, Scherzer R, Peralta CA, Tien PC, Grunfeld C, Estrella MM, Abraham A, Gustafson DR, Nowicki M, Sharma A, Cohen MH, Butch AW, Young MA, Bennett MR, Shlipak MG. Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women. Hypertension 2016; 69:304-313. [PMID: 27993956 DOI: 10.1161/hypertensionaha.116.08258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/16/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022]
Abstract
Subclinical kidney disease is associated with developing hypertension in the general population, but data are lacking among HIV-infected people. We examined associations of kidney function and injury with incident hypertension in 823 HIV-infected and 267 HIV-uninfected women in the Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-infected and uninfected women in the United States. Baseline kidney biomarkers included estimated glomerular filtration rate using cystatin C, urine albumin-to-creatinine ratio, and 7 urine biomarkers of tubular injury: α-1-microglobulin, interleukin-18, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, liver fatty acid-binding protein, N-acetyl-β-d-glucosaminidase, and α1-acid-glycoprotein. We used multivariable Poisson regression to evaluate associations of kidney biomarkers with incident hypertension, defined as 2 consecutive visits of antihypertensive medication use. During a median follow-up of 9.6 years, 288 HIV-infected women (35%) developed hypertension. Among the HIV-infected women, higher urine albumin-to-creatinine ratio was independently associated with incident hypertension (relative risk =1.13 per urine albumin-to-creatinine ratio doubling, 95% confidence interval, 1.07-1.20), as was lower estimated glomerular filtration rate (relative risk =1.10 per 10 mL/min/1.73 m2 lower estimated glomerular filtration rate; 95% confidence interval, 1.04-1.17). No tubular injury and dysfunction biomarkers were independently associated with incident hypertension in HIV-infected women. In contrast, among the HIV-uninfected women, urine albumin-to-creatinine ratio was not associated with incident hypertension, whereas higher urine interleukin-18, α1-acid-glycoprotein, and N-acetyl-β-d-glucosaminidase levels were significantly associated with incident hypertension. These findings suggest that early glomerular injury and kidney dysfunction may be involved in the pathogenesis of hypertension in HIV-infected people. The associations of tubular markers with hypertension in HIV-uninfected women should be validated in other studies.
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Affiliation(s)
- Simon B Ascher
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Rebecca Scherzer
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Carmen A Peralta
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Phyllis C Tien
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Carl Grunfeld
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Michelle M Estrella
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Alison Abraham
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Deborah R Gustafson
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Marek Nowicki
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Anjali Sharma
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Mardge H Cohen
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Anthony W Butch
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Mary A Young
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Michael R Bennett
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.)
| | - Michael G Shlipak
- From the Kidney Health Research Collaborative, Department of Medicine, San Francisco VA Medical Center (S.B.A., R.S., C.A.P., P.C.T., C.G., M.G.S.) and Department of Epidemiology and Biostatistics (C.A.P., P.C.T., C.G., M.G.S.), University of California, San Francisco; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.M.E., A.A.); Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY (D.R.G.); Department of Medicine, University of Southern California, Los Angeles (M.N.); Department of Medicine, Albert Einstein College of Medicine, Bronx, NY (A.S.); Department of Medicine, Stroger Hospital and Rush University, Chicago, IL (M.H.C.); Department of Pathology and Laboratory Medicine, UCLA Health System, Los Angeles, CA (A.W.B.); Georgetown University Medical Center, Washington, DC (M.A.Y.); and Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, OH (M.R.B.).
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22
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Angkurawaranon C, Nitsch D, Larke N, Rehman AM, Smeeth L, Addo J. Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease? PLoS One 2016; 11:e0166375. [PMID: 27855194 PMCID: PMC5113946 DOI: 10.1371/journal.pone.0166375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/27/2016] [Indexed: 12/01/2022] Open
Abstract
METHODS Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda's hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population. RESULTS In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage. CONCLUSIONS Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.
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Affiliation(s)
- C. Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - D Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - N Larke
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A. M. Rehman
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - L. Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - J. Addo
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Martin-Iguacel R, Llibre JM, Friis-Moller N. Risk of Cardiovascular Disease in an Aging HIV Population: Where Are We Now? Curr HIV/AIDS Rep 2016; 12:375-87. [PMID: 26423407 DOI: 10.1007/s11904-015-0284-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
With more effective and widespread antiretroviral treatment, the overall incidence of AIDS- or HIV-related death has decreased dramatically. Consequently, as patients are aging, cardiovascular disease (CVD) has emerged as an important cause of morbidity and mortality in the HIV population. The incidence of CVD overall in HIV is relatively low, but it is approximately 1.5-2-fold higher than that seen in age-matched HIV-uninfected individuals. Multiple factors are believed to explain this excess in risk such as overrepresentation of traditional cardiovascular risk factors (particularly smoking), toxicities associated with cumulative exposure to some antiretroviral agents, together with persistent chronic inflammation, and immune activation associated with HIV infection. Tools are available to calculate an individual's predicted risk of CVD and should be incorporated in the regular follow-up of HIV-infected patients. Targeted interventions to reduce this risk must be recommended, including life-style changes and medical interventions that might include changes in antiretroviral therapy.
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Affiliation(s)
- R Martin-Iguacel
- Infectious Diseases Department, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
| | - J M Llibre
- HIV Unit and "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - N Friis-Moller
- Infectious Diseases Department, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
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Incidence and predictors of hypertension in adults with HIV-initiating antiretroviral therapy in south-western Uganda. J Hypertens 2016; 33:2039-45. [PMID: 26431192 DOI: 10.1097/hjh.0000000000000657] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The successful scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has led to increasing life expectancy, and thus increased risk of hypertension. We aimed to describe the incidence and predictors of hypertension in HIV patients receiving ART at a publicly funded clinic in rural Uganda. METHODS We abstracted data from medical records of adult patients who initiated ART at an HIV clinic in south-western Uganda during 2010-2012. We defined hypertension as at least two consecutive clinical visits, with a SBP at least 140 mmHg and/or SBP of at least 90 mmHg, or prescription for an antihypertensive medication. We calculated the incidence of hypertension and fit multivariable Cox proportional-hazards models to identify predictors of hypertension. RESULTS A total of 3389 patients initiated ART without a prior diagnosis of hypertension during the observation period. Over 3990 person-years of follow-up, 445 patients developed hypertension, for a crude incidence of 111.5/1000 (95% confidence interval 101.9-121.7) person-years. Rates were highest among men aged at least 40 years (158.8 per/1000 person-years) and lowest in women aged 30-39 years (80/1000 person-years). Lower CD4 cell count at ART initiation, as well as traditional risk factors including male sex, increasing age, and obesity, were independently associated with hypertension. CONCLUSION We observed a high incidence of hypertension in HIV-infected persons on ART in rural Uganda, and increased risk with lower nadir CD4 cell counts. Our findings call for increased attention to screening of and treatment for hypertension, along with continued prioritization of early ART initiation.
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Martin-Iguacel R, Negredo E, Peck R, Friis-Møller N. Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV. Curr Hypertens Rep 2016; 18:46. [PMID: 27131801 PMCID: PMC5546311 DOI: 10.1007/s11906-016-0656-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With widespread and effective antiretroviral therapy, the life expectancy in the HIV population has dramatically improved over the last two decades. Consequently, as patients are aging with HIV, other age-related comorbidities, such as metabolic disturbances and cardiovascular disease (CVD), have emerged as important causes of morbidity and mortality. An overrepresentation of traditional cardiovascular risk factors (RF), toxicities associated with long exposure to antiretroviral therapy, together with residual chronic inflammation and immune activation associated with HIV infection are thought to predispose to these metabolic complications and to the excess risk of CVD observed in the HIV population. The metabolic syndrome (MS) represents a clustering of RF for CVD that includes abdominal obesity, hypertension, dyslipidemia and insulin resistance. Hypertension is a prevalent feature of the MS in HIV, in particular in the aging population, and constitutes an important RF for CVD. Physicians should screen their patients for metabolic and cardiovascular risk at the regular visits to reduce MS and the associated CVD risk among people aging with HIV, since many of RF are under-diagnosed and under-treated conditions. Interventions to reduce these RF can include lifestyle changes and pharmacological interventions such as antihypertensive and lipid-lowering therapy, and treatment of glucose metabolism disturbances. Changes in antiretroviral therapy to more metabolic neutral antiretroviral drugs may also be considered.
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Affiliation(s)
- Raquel Martin-Iguacel
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark.
| | - Eugènia Negredo
- "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Nina Friis-Møller
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark
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van Zoest RA, Wit FW, Kooij KW, van der Valk M, Schouten J, Kootstra NA, Wiersinga WJ, Prins M, van den Born BJH, Reiss P. Higher Prevalence of Hypertension in HIV-1-Infected Patients on Combination Antiretroviral Therapy Is Associated With Changes in Body Composition and Prior Stavudine Exposure. Clin Infect Dis 2016; 63:205-13. [PMID: 27143668 DOI: 10.1093/cid/ciw285] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/16/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Individuals infected with human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease, potentially partly mediated by a higher prevalence of hypertension. We therefore examined the prevalence and determinants of hypertension in HIV-1-infected patients compared with appropriate HIV-negative controls. METHODS Data from 527 HIV-1-infected and 517 HIV-uninfected participants at the time of enrollment into the ongoing AGEhIV Cohort Study were analyzed. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or self-reported use of antihypertensive drugs. RESULTS Hypertension prevalence was higher among HIV-1-infected individuals compared with controls (48.2% vs 36.4%; odds ratio [OR], 1.63; 95% confidence interval [CI], 1.27-2.09). In logistic regression models adjusted for age, sex, ethnicity, family history of hypertension, smoking, alcohol use, physical activity, and body mass index, the association between HIV and hypertension remained statistically significant (ORHIV, 1.65; 95% CI, 1.25-2.19), but was attenuated after additional adjustment for waist-to-hip ratio (ORHIV, 1.29; 95% CI, .95-1.76). Among HIV-1-infected individuals, particularly among those with mono/dual nucleoside reverse transcriptase inhibitor therapy prior to combination antiretroviral therapy, stavudine exposure was independently associated with hypertension (ORstavudine, 1.54; 95% CI, 1.04-2.30). This association was attenuated after additional adjustment for either waist-to-hip ratio (ORstavudine, 1.30; 95% CI, .85-1.96) or hip circumference (ORstavudine, 1.40; 95% CI, .93-2.11). CONCLUSIONS Our findings suggest that changes in body composition, involving both abdominal obesity and stavudine-induced peripheral lipoatrophy, might contribute to the higher prevalence of hypertension in HIV-1-infected patients. CLINICAL TRIALS REGISTRATION NCT01466582.
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Affiliation(s)
- Rosan A van Zoest
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Ferdinand W Wit
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center HIV Monitoring Foundation
| | - Katherine W Kooij
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center
| | | | | | - W Joost Wiersinga
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center
| | - Maria Prins
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center Department of Infectious Diseases Research Cluster, Public Health Service Amsterdam
| | | | - Peter Reiss
- Department of Global Health, Academic Medical Center, and Amsterdam Institute for Global Health and Development Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center HIV Monitoring Foundation
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Okeke NL, Davy T, Eron JJ, Napravnik S. Hypertension Among HIV-infected Patients in Clinical Care, 1996-2013. Clin Infect Dis 2016; 63:242-8. [PMID: 27090989 DOI: 10.1093/cid/ciw223] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/03/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Persons infected with human immunodeficiency virus (HIV) are at higher risk for major cardiovascular disease (CVD) events than uninfected persons. Understanding the epidemiology of major traditional CVD risk determinants, particularly hypertension, in this population is needed. METHODS The study population included HIV-infected patients participating in the UNC CFAR HIV Clinical Cohort from 1996 to 2013. Annual incidence rates of hypertension were calculated. Multivariable Poisson models were fit to identify factors associated with incident hypertension. RESULTS 3141 patients contributed 21 956 person-years (PY) of follow-up. Overall, 57% patients were black, 28% were women, and the median age was 35 years. Hypertension age-standardized incidence rates increased from 1.68 cases per 100 PYs in 1996 to 5.35 cases per 100 PYs in 2013 (P < .001). In adjusted analyses, hypertension rates were higher among obese patients (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI], 1.43-2.02), and those with diabetes mellitus (IRR 1.44, 95% CI, 1.14-1.83) and renal insufficiency (IRR 1.36, 95% CI, 1.16-1.61), but lower among patients with a CD4 nadir of ≥500 cells/mm(3) (IRR 0.73, 95% CI, .53-1.01). CONCLUSIONS The incidence of hypertension increased from 1996 to 2013, alongside increases in traditional hypertension risk determinants. Notably, HIV-related immunosuppression and ongoing viral replication may contribute to an increased hypertension risk. Aggressive CVD risk factor management, early HIV diagnosis, linkage to care, antiretroviral therapy initiation, and durable viral suppression, will be important components of a comprehensive primary CVD prevention strategy in HIV-infected persons.
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Affiliation(s)
- Nwora Lance Okeke
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, Duke University, Durham
| | - Thibaut Davy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Joseph J Eron
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
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Kent ST, Burkholder GA, Tajeu GS, Overton ET, Muntner P. Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV. Curr Hypertens Rep 2016; 17:88. [PMID: 26429228 DOI: 10.1007/s11906-015-0598-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.
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Affiliation(s)
- Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA.
| | - Greer A Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriel S Tajeu
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
| | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
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Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol 2015; 9:S1-122.e1. [DOI: 10.1016/j.jacl.2015.09.002] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis. J Hum Hypertens 2015; 30:355-62. [PMID: 26446389 DOI: 10.1038/jhh.2015.97] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 11/08/2022]
Abstract
Owing to antiretroviral drug-induced endothelial dysfunction, HIV-infected patients on antiretroviral therapy (ART) may have elevated blood pressure. We conducted a systematic review and meta-analysis to estimate the effects of ART on blood pressure levels and hypertension risk among HIV-infected populations worldwide. We sought articles that compared the mean blood pressure measurements and hypertension prevalence between HIV-infected adults naive and exposed to ART. Thirty-nine studies comprising 44 903 participants met the inclusion criteria. Overall, systolic (mean difference (MD) 4.52 mm Hg, 95% confidence interval (CI) 2.65-6.39, I(2)=68.1%, 19 studies) and diastolic blood pressure levels (MD 3.17 mm Hg, 95% CI 1.71-4.64, I(2)=72.5%, 16 studies) were significantly higher among ART-exposed patients compared with treatment-naive patients. Similarly, the risk of hypertension was significantly higher among ART-exposed patients, such that among 28 908 ART-exposed patients, 4195 (14.5%) had hypertension compared with 950 of 9086 (10.5%) in those who were treatment-naive (odds ratio 1.68, 95% CI 1.35-2.10, I(2)=81.5%, 32 studies). In summary, exposure to ART is significantly associated with increased systolic and diastolic blood pressure levels, and increased risk of hypertension, regardless of study-level sociodemographic differences. This meta-analysis supports the need for population-based strategies to reduce the risk of high blood pressure among people living with HIV on ART.
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Chastain DB, Henderson H, Stover KR. Epidemiology and management of antiretroviral-associated cardiovascular disease. Open AIDS J 2015; 9:23-37. [PMID: 25866592 PMCID: PMC4391206 DOI: 10.2174/1874613601509010023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/21/2015] [Accepted: 02/22/2015] [Indexed: 02/07/2023] Open
Abstract
Risk and manifestations of cardiovascular disease (CVD) in patients infected with human immunodeficiency virus (HIV) will continue to evolve as improved treatments and life expectancy of these patients increases. Although initiation of antiretroviral (ARV) therapy has been shown to reduce this risk, some ARV medications may induce metabolic abnormalities, further compounding the risk of CVD. In this patient population, both pharmacologic and nonpharmacologic strategies should be employed to treat and reduce further risk of CVD. This review summarizes epidemiology data of the risk factors and development of CVD in HIV and provides recommendations to manage CVD in HIV-infected patients.
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Affiliation(s)
- Daniel B Chastain
- Phoebe Putney Memorial Hospital, Department of Pharmacy, Albany, GA, USA
| | - Harold Henderson
- University of Mississippi Medical Center, Department of Medicine-Infectious Diseases, Jackson, MS, USA
| | - Kayla R Stover
- University of Mississippi Medical Center, Department of Medicine-Infectious Diseases, Jackson, MS, USA ; University of Mississippi School of Pharmacy, Department of Pharmacy Practice, Jackson, MS, USA
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32
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Antonello VS, Antonello ICF, Grossmann TK, Tovo CV, Pupo BBD, Winckler LDQ. Hypertension--an emerging cardiovascular risk factor in HIV infection. ACTA ACUST UNITED AC 2015; 9:403-7. [PMID: 25979413 DOI: 10.1016/j.jash.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022]
Abstract
Patients with HIV may have an increased risk of hypertension and cardiovascular disease (CVD). The objective of this study was to determine the prevalence and risk factors for hypertension in a population of HIV-infected patients at an HIV/AIDS clinic in southern Brazil. We reviewed medical records of 1009 HIV-infected patients aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, southern Brazil. Hypertension was defined according to the Eighth Joint National Committee criteria. The prevalence of hypertension in this study cohort was 22.5% (95% confidence interval, 20%-25.2%). Individuals were significantly older in the hypertensive group (P < .001). After adjustment using a Poisson regression model of all variables that presented P < .2 in the univariate analysis, the variables that were significantly associated with hypertension were only age ≥40 years and obesity. Also in this setting, dyslipidemia (P = .068) showed a tendency of association with hypertension. Compared with HIV-infected persons aged 18-39 years, those aged 40-59 years presented a 2-fold higher prevalence of hypertension (95% confidence interval, 1.2-3.3).The present study showed a high prevalence of hypertension among HIV-infected persons, similar to other studies, ranging from 13% to 45%, and also similar to the HIV-negative general population. Age and obesity were the factors associated with hypertension. Finally, the present study indicates a similar pattern of behavior and comorbidities for HIV-positive and -negative patients in relation to hypertension.
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Affiliation(s)
- Vicente Sperb Antonello
- IAPI HIV Clinic, Porto Alegre, Brazil; Department of Infection Prevention and Control, Hospital Fêmina, Porto Alegre, Brazil; Post Graduate Course in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
| | - Ivan Carlos Ferreira Antonello
- Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago Kreutz Grossmann
- Graduate Program in Medicine and Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane Valle Tovo
- Post Graduate Course in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Brasil Dal Pupo
- Graduate Program in Medicine and Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Tripathi A, Jerrell JM, Skelton TN, Nickels MA, Duffus WA. Incidence of primary hypertension in a population-based cohort of HIV-infected compared with non-HIV-infected persons and the effect of combined antiretroviral therapy. ACTA ACUST UNITED AC 2015; 9:351-7. [PMID: 25766497 DOI: 10.1016/j.jash.2015.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/08/2014] [Accepted: 01/09/2015] [Indexed: 01/16/2023]
Abstract
Literature remains scarce on the impact of antiretroviral medications on hypertension in the HIV population. We used the South Carolina Medicaid database linked with the enhanced HIV/AIDS system surveillance database for 1994-2011 to evaluate incident hypertension and the impact of combination antiretroviral therapy (cART) in HIV/AIDS population compared with a propensity- matched non-HIV control group. Multivariable, time-dependent survival analysis suggested no significant difference in incidence of hypertension between the HIV group and the non-HIV control group. However, subgroup analysis suggested that among the HIV-infected group, months of exposure to both non-nucleoside reverse transcriptase inhibitors (adjusted hazard ratio, 1.52; 95% confidence interval, 1.3-1.75) and protease inhibitors (adjusted hazard ratio, 1.26; 95% confidence interval, 1.11-1.44) were associated with an increased risk of incident hypertension after adjusting for traditional demographic and metabolic risk factors. In people with HIV/AIDS, prolonged exposure to both protease inhibitor-based and non-nucleoside reverse transcriptase inhibitor-based cART may increase the risk of incident hypertension.
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Affiliation(s)
- Avnish Tripathi
- Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA.
| | - Jeanette M Jerrell
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Thomas N Skelton
- Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Myrna A Nickels
- Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Wayne A Duffus
- Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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Documento de consenso sobre alteraciones metabólicas y riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2015; 33:40.e1-40.e16. [DOI: 10.1016/j.eimc.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/18/2014] [Indexed: 01/20/2023]
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Vecchiet J, Ucciferri C, Falasca K, Mancino P, Di Iorio A, De Caterina R. Antihypertensive and metabolic effects of telmisartan in hypertensive HIV-positive patients. Antivir Ther 2012; 16:639-45. [PMID: 21817185 DOI: 10.3851/imp1809] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hypertension is more prevalent among HIV-infected individuals than in the general population and contributes to increased cardiovascular risk. The angiotensin II receptor blocker telmisartan is also a partial peroxisome proliferator activated receptor-γ agonist with documented effects on glucose and lipid homeostasis. The aim of this study was to evaluate the antihypertensive and metabolic effects of telmisartan in hypertensive HIV-positive patients. METHODS A total of 18 HIV-positive men treated with antiretroviral therapy and recently diagnosed with hypertension were administered 80 mg telmisartan daily. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), viroimmunological and metabolic parameters, insulin resistance, C-reactive protein, microalbuminuria, cystatin C and plasma levels of interleukin-18 and endothelin-1 were measured at baseline (T0), 1 month (T1), 3 months (T3) and 6 months (T6). RESULTS Treatment with telmisartan not only decreased SBP and DBP levels, but also improved insulin resistance and microalbuminuria by T1. Levels of triglycerides significantly decreased and high-density lipoprotein cholesterol increased at T1, whereas total and low-density lipoprotein cholesterol levels were statistically reduced at T3 and T6. Cystatin C and endothelin-1 showed a significant reduction at T1, whereas interleukin-18 decreased at both T3 and T6. CONCLUSIONS Telmisartan was effective in reducing blood pressure and improving lipid metabolism and renal function. Reduction of endothelin-1 might be related to an endothelial protective effect. On the basis of these findings, and because of properties unrelated to blood pressure lowering, telmisartan might be the first choice antihypertensive drug for the treatment of HIV-positive patients.
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Affiliation(s)
- Jacopo Vecchiet
- Division of Infectious Diseases, Department of Medicine and Sciences of Aging, G d'Annunzio University School of Medicine, Chieti, Italy.
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Boccara F, Auclair M, Cohen A, Lefèvre C, Prot M, Bastard JP, Capeau J, Caron-Debarle M. HIV protease inhibitors activate the adipocyte renin angiotensin system. Antivir Ther 2010; 15:363-75. [DOI: 10.3851/imp1533] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Brañas F, Serra JA. [HIV Infection in the elderly]. Rev Esp Geriatr Gerontol 2009; 44:149-154. [PMID: 19443084 DOI: 10.1016/j.regg.2008.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 05/27/2023]
Abstract
HIV infection is increasingly common in the elderly. This population is a heterogeneous group with particular epidemiologic characteristics and often with associated comorbidities, which frequently delay diagnosis and lead to poor immunological status at the start of highly active antiretroviral therapy (HAART). There are no differences between elderly and young HIV infected patients in the recommended antiretroviral regimens. Tolerance to treatment is good and the virological and immunological response to HAART is positive, although immunological response is slower and lower than in younger patients. Treatment adherence, which has been shown to be the only protective independent factor related to virological failure, is better in the elderly.
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Affiliation(s)
- Fátima Brañas
- Servicio de Geriatría, Hospital Infanta Leonor, Madrid, España.
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38
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Kline ER, Sutliff RL. The roles of HIV-1 proteins and antiretroviral drug therapy in HIV-1-associated endothelial dysfunction. J Investig Med 2008; 56:752-69. [PMID: 18525451 PMCID: PMC2586126 DOI: 10.1097/jim.0b013e3181788d15] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the emergence of highly active antiretroviral therapy (HAART), human immunodeficiency virus-1 (HIV-1)-infected patients have demonstrated dramatic decreases in viral burden and opportunistic infections, and an overall increase in life expectancy. Despite these positive HAART-associated outcomes, it has become increasingly clear that HIV-1 patients have an enhanced risk of developing cardiovascular disease over time. Clinical studies are instrumental in our understanding of vascular dysfunction in the context of HIV-1 infection. However, most clinical studies often do not distinguish whether HIV-1 proteins, HAART, or a combination of these 2 factors cause cardiovascular complications. This review seeks to address the roles of both HIV-1 proteins and antiretroviral drugs in the development of endothelial dysfunction because endothelial dysfunction is the hallmark initial step of many cardiovascular diseases. We analyze recent in vitro and in vivo studies examining endothelial toxicity in response to HIV-1 proteins or in response to the various classes of antiretroviral drugs. Furthermore, we discuss the multiple mechanisms by which HIV-1 proteins and HAART injure the vascular endothelium in HIV-1 patients. By understanding the molecular mechanisms of HIV-1 protein- and antiretroviral-induced cardiovascular disease, we may ultimately improve the quality of life of HIV-1 patients through better drug design and the discovery of new pharmacological targets.
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Affiliation(s)
- Erik R Kline
- Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine, Emory University/Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
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