Hypertension and Metabolic Syndrome in Persons with HIV

Abstract

Purpose of Review With the advent of highly active antiretroviral therapy (ART), the life span of persons with HIV (PWH) has been nearly normalized. With aging, prevalence of the metabolic syndrome (MetS), including hypertension, has increased in the HIV population and exceeds that in the general population in some studies. This is due to a combination of traditional risk factors in addition to the effects attributable to the virus and ART. We review recent findings on the mechanisms contributing to MetS and hypertension in PWH, particularly those specific to the viral infection and to ART. Recent Findings Activation of the renin-angiotensin-aldosterone system (RAAS) and chronic immune activation contribute to the development of MetS and hypertension in PWH. HIV proteins and some ART agents alter adipocyte health contributing to dyslipidemias, weight gain, and insulin resistance. HIV infection also contributes to hypertension by direct effects on the RAAS that intertwine with inflammation by the RAAS also contributing to T cell activation. Summary Recent data suggest that in addition to current ART, therapeutic targeting of the MetS and hypertension in PWH, by interfering with the RAAS, treating insulin resistance directly or by use of immunomodulators that dampen inflammation, may be critical for preventing or treating these risk factors and to improve overall cardiovascular complications in the HIV-infected aging population.

Metabolic syndrome and body weight in people living with HIV infection: analysis of differences observed in three different cohort studies over a decade

“…Importantly, it should be noted that blood lipids and body weight in PHIV also depend on the baseline characteristics of the study participants, despite some concerns about modern antiretrovirals [12,17,47–50], and that the adherence to educational and therapeutic interventions could be important in the prevention of cardiovascular risk, besides the choice of ART. Finally, we found a higher risk of MS in older study participants, as expected [51] and in those with higher CD4 counts, which was unexpected. Low CD4 nadir has been reported as a risk factor for MS and hypertension [51,52], while current high CD4 count is not usually considered as a risk factor.…”

“…Finally, we found a higher risk of MS in older study participants, as expected [51] and in those with higher CD4 counts, which was unexpected. Low CD4 nadir has been reported as a risk factor for MS and hypertension [51,52], while current high CD4 count is not usually considered as a risk factor. However, it is possible that higher CD4 counts could reflect, in general, good health and well‐being, but also that study participants with higher CD4 count were those with better adherence to ART, and thus were free from toxicities like nausea or gastrointestinal side effects.…”

Expression of Killer Immunoglobulin Receptor Genes among HIV-Infected Individuals with Non-AIDS Comorbidities

“…Our data showed that the frequency of comorbid conditions was higher among HIV-positive individuals > 40 years compared to those ≤40 years of age ( Abou Hassan et al submitted manuscript ). In accordance with previous reports from our group ( Hammad et al accepted manuscript JIDC ) and worldwide [ 14 , 49 – 52 ], the most commonly reported comorbidities among our study participants were hypertension and hyperlipidemia followed by CVD and diabetes.…”

Contribution of Adipose Tissue to the Chronic Immune Activation and Inflammation Associated With HIV Infection and Its Treatment

“…Conversely, blocking or preventing RAS activation in AT can reduce oxidative stress, improve insulin resistance and reduce inflammation (173,174). Interactions between the RAS and HIV infection have been described, and could contribute to AT inflammation, but also to the onset of metabolic syndrome and hypertension in PLWH (175,176).…”