Hypertension among HIV-Infected Adults Receiving Highly Active Antiretroviral Therapy (HAART) in Malaysia

Abstract

There are increasing researches about non-communicable disease such as elevated blood pressure among people living with HIV before and after initiation of highly active antiretroviral therapy (HAART). This cross-sectional study was designed to determine the prevalence of hypertension and associated risk factors among 340 HIV-infected patients on antiretroviral therapy at a Malaysian public hospital providing HIV-related treatment. Data on socioeconomic background, anthropometry, medical history and dietary intake of the patients were collected. Hypertension is defined as blood pressure ≥130/85 (mm Hg). Prevalence of hypertension was 45.60% (n=155) of which 86.5% of the hypertensive group were male (n=134). The results showed that increase in age (OR 1.051, 95% confidence interval (CI) 1.024-1.078), higher body mass index (OR 1.18, 95% CI 1.106-2.71), bigger waist circumference (OR 1.18, 95%CI 1.106-2.71), higher waist-hip ratio (OR 1.070, 95%CI 1.034-1.106), higher fasting plasma glucose (OR 1.332, 95% CI 0.845-2.100) and percentage energy intake from protein >15 (OR 2.519, 95%CI 1.391-4.561) were significant risk factors for hypertension (p<0.001). After adjusting for other variables, increasing age (adjusted odds ratio (aOR) 1.069 95%CI 1.016-1.124, p=0.010), being male (aOR 3.026, 95%CI 1.175-7.794, p=0.022) and higher body mass index (aOR 1.26, 95%CI 1.032-1.551, p=0.024) were independently associated with hypertension. None of the antiretroviral therapy and immunologic factors was linked to hypertension. In conclusion hypertension among PLHIV was linked to the well-known risk factors such as age, gender and body mass index. With HAART, people can live longer by making monitoring and control of some reversible factors, especially excessive weight gain for maintaining quality of life.

Drug induced hypertension – An unappreciated cause of secondary hypertension

“…Although Highly active antiretroviral therapy (HAART) has been reported to increase systolic blood pressure, recent studies reported that hypertension was associated with traditional cardio metabolic risk factors and was unassociated with the treatment itself (Hejazi et al, 2014;Krauskopf et al, 2013). Even when reported to be associated with hypertension, HAART does not usually increase blood pressure before 6 months of use(Grandominico and Fichtenbaum, baseline systolic blood pressure, higher baseline cholesterol levels and low baseline CD4-cell count (Baekken et al, 2008).…”

Metabolic Abnormalities in HIV-Infected Populations without or with Antiretroviral Therapy (ART)

“…Globally, the occurrence of dyslipidemia in HIV-seropositive patients receiving ART has been recently estimated to be between 20% and 80% [77][78][79][80][81][82][83][84][85][86][87][88][89][90]. The highest incidence of metabolic abnormality is increased serum TG concentration (hypertriglyceridemia), which is seen in the majority of HIV cases (40-80%), followed by hypercholesterolemia (10-60%), low HDL level (20-40%), and hyperglycemia or hyperinsulinemia (5-30%), whereas the lowest incidence is for diabetes (10-20%), as shown by different studies [81][82][83][84][85][86][87][88][89][90].…”

“…Importantly, receivers of PIs experienced the most unfavorable metabolic changes [77][78][79][80][81][82][83]. Also, early reports in 2000 on the side effects of PIs highlighted the incidence of high concentrations of the lipid profile as being close to 80% [77][78][79] in various global populations, mostly from I.…”

“…Fewer studies have been conducted in some regions in South America and Asia on the relationship between metabolic disorders and ART. In Malaysia, studies in large (1,583) and small (340) samples of HIV populations found that up to 80% of the subjects had dyslipidemia rates, whereas hypertriglyceridemia and hypercholesterolemia were frequently prevalent in more than half of the population and low level of HDL, raised LDL-c, and hyperglycemia were common in less than 30-40% of studied populations [81][82][83]. Also, hyperglycemia incidences were documented in 27% of HIV cases in Thailand [93,99] and 60% in the HIV population in India [96].…”

“…Outcomes from a number of investigations among adult patients have shown the following risk factors for hypertriglyceridemia: male gender, older age (>36 years), higher body mass index (BMI), abdominal obesity, overweight or obesity, homosexuality, AIDS, higher CD4 cell count, and hypercholesterolemia and hypertriglyceridemia in baseline time (before the PI therapy) [81][82][83][122][123][124][125]. Outcomes from a number of investigations among adult patients have shown the following risk factors for hypertriglyceridemia: male gender, older age (>36 years), higher body mass index (BMI), abdominal obesity, overweight or obesity, homosexuality, AIDS, higher CD4 cell count, and hypercholesterolemia and hypertriglyceridemia in baseline time (before the PI therapy) [81][82][83][122][123][124][125].…”