Hypertension in HIV-Infected Adults

Fahme, Sasha Abdallah; Bloomfield, Gerald S.; Peck, Robert

doi:10.1161/hypertensionaha.118.10893

Cited by 152 publications

(120 citation statements)

References 114 publications

(202 reference statements)

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“…This combination of lower blood pressure before ART initiation and a more rapid increase in blood pressure after ART initiation leads us to an important question—why are the dynamics of blood pressure different in PWH in the early ART period? The answer to this question likely involves a complex interplay between traditional and HIV‐specific risk factors such as immune reconstitution 20 . Several recent cross‐sectional studies have shown that PWH on established ART have the same or less hypertension than HIV‐uninfected controls 21‐23 .…”

Section: Discussionmentioning

confidence: 99%

Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy

Reis

Desderius

Kingery

et al. 2020

J of Clinical Hypertension

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Cardiovascular disease is now a leading cause of mortality in people with HIV (PWH). High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study in Tanzania, the authors conducted unobserved blood pressure measurements at enrollment, 3, 6, 12, 18, and 24 months in 500 PWH initiating ART and 504 HIV-uninfected adults. The authors excluded measurements taken on antihypertensive medications. Although PWH had a significantly lower blood pressure before ART initiation, they had a significantly greater increase in blood pressure during the first 2 years of ART compared to HIV-uninfected controls. Blood pressure correlates in PWH differed from HIV-uninfected controls. In PWH, lower baseline CD4 + T-cell counts were associated with lower blood pressure, and greater increases in CD4 + T-cell counts on ART were associated with greater increases in blood pressure, both on average and within individuals. In addition, PWH with a systolic blood pressure (SBP) <90 mm Hg at the time of ART initiation had ~30% mortality in the following 3 months due to occult infections. These patients require careful investigation for occult infections, and those with tuberculosis may benefit from corticosteroids. | 1555 REIS Et al.

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Section: Discussionmentioning

confidence: 99%

Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy

Reis

Desderius

Kingery

et al. 2020

J of Clinical Hypertension

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“…With prolonged survival and aging of persons with HIV, chronic comorbidities, including hypertension, have emerged as significant causes of morbidity and mortality among these patients with access to ART [4,5]. Hypertension is now recognized as an important chronic comorbid condition occurring in people living with HIV and is associated with increased morbidity and mortality [6,7]. In patients with HIV, hypertension has been shown to be associated with an increased risk for hospitalization and adverse cardiovascular and renal outcomes, including progression to end-stage renal disease that consequently reduces life expectancy and add to the already high costs of treatment for this population [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…People living with HIV on combination ART are at an increased risk for hypertension than HIV-uninfected individuals [6,11]. Data from around the globe demonstrated that 35% of all HIV-infected adults on ART have hypertension, compared with an estimated 30% of HIV-uninfected adults [12].…”

Section: Introductionmentioning

confidence: 99%

Hypertension in HIV-Infected Patients Receiving Antiretroviral Therapy in Northeast Ethiopia

Fiseha

Gedefie

Dereje

et al. 2019

International Journal of Hypertension

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Background. With prolonged survival and aging of persons with HIV on combination antiretroviral therapy (ART), hypertension has emerged as a significant cause of morbidity and mortality globally. However, little is known about the burden of this comorbid condition among adults living with HIV in sub-Saharan Africa. In this study, we aimed to determine the prevalence and factors associated with hypertension among HIV-infected patients receiving ART in Northeast Ethiopia. Methods. A cross-sectional study was conducted at the ART clinic of Dessie Referral Hospital, Northeast Ethiopia, between January and May 2018. HIV-infected patients who were on ART for at least 12 months were included in the study. Demographic, clinical, and laboratory data were collected from each participant. Hypertension was defined as a systolic blood pressure (BP) of ≥140 mmHg and/or diastolic BP of ≥90 mmHg or a reported use of antihypertensive medication. Univariable and multivariate analyses were performed to identify factors associated with hypertension. Results. A total of 408 patients were studied with a mean (±SD) age of 37 ± 10.3 years, and 66.9% were female. The prevalence of hypertension was 29.7% (95% CI, 25.3–35.0%). Nearly 75% of the patients with hypertension were previously undiagnosed. In a univariate analysis, older age, male gender, a family history of hypertension, duration of HIV infection, duration on ART, high body mass index, low CD4 count, diabetes, and renal impairment were associated with hypertension. Multivariate analysis revealed older age (AOR = 2.08; 95% CI, 1.13–3.83), male gender (AOR = 1.64; 95% CI, 1.01–2.65), longer duration on ART (AOR = 1.91; 95% CI, 1.14–3.20), high body mass index (AOR = 3.32; 95% CI, 1.13–9.77), and diabetes (AOR = 2.76; 95% CI, 1.29–5.89) as independent risk factors of hypertension. Conclusions. Hypertension is highly prevalent among HIV-infected patients on ART attending our clinic in Northeast Ethiopia but is mostly undiagnosed. These findings highlight the need for integrating hypertension management into routine HIV care to prevent adverse outcomes and improve health of people living with HIV on ART.

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“…Chatterton-Kirchmeier et al reported a signi cantly higher prevalence of elevated blood pressure in a cohort of HIV-infected, predominantly African-American adolescents and young adults in the US compared to healthy children [211]. Globally, studies involving HIV-infected adults have demonstrated higher hypertension prevalence than the general population [212] and hypertension has been found to be associated with ART [213,214]. One in ve young adults (18-35 years) attending an HIV clinic in the same setting in Khayelitsha had comorbid hypertension [65].…”

Section: Other Ncd Comorbiditymentioning

confidence: 99%

Epidemiology of Non-communicable Diseases and Risk factors in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention

Kamkuemah¹,

Gausi²,

Oni³

2020

Preprint

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Background Adolescents and youth living with HIV (AYLHIV) face an elevated NCD risk resulting from HIV, psychosocial challenges and the complications of antiretroviral therapy (ART). Methods We conducted a cross-sectional study in six primary care facilities to investigate the prevalence of common NCDs and risk factors among AYLHIV in Cape Town, South Africa between March 2019 and January 2020. We collected information on pre-existent and previously unidentified NCDs and risk factors and collected sociodemographic information of adolescents and youth enrolled for primary HIV care. Characteristics between sexes and age groups were compared using parametric or non-parametric statistical tests. Results Three out of four participants were female, and the median age was 20.5 years (IQR 18.9–22.9). More than a quarter were not in education, employment or training (NEET) and 44% were multidimensionally poor. Our results show an existent burden of hypertension (5%) and central obesity (37%) as well as high levels of depression (43%) and psychological distress symptoms (44%). AYLHIV further self-reported high levels of household food insecurity (70%), low fruit and vegetable consumption, high fast-food and sugar-sweetened beverage intake, low nutritional knowledge and insufficient physical activity. Beyond the NCD risk attributable to HIV and ART, these multiple risk factors coupled with early initiation of high-risk behaviours like smoking, alcohol and drug use, further increase risk. Conclusions Our findings highlight the importance of integrated prevention with NCD risk screening as part of HIV care for AYLHIV and the need for early intervention on social, environmental and economic determinants of NCDs targeting adolescents and youth.

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Hypertension in HIV-Infected Adults

Cited by 152 publications

References 114 publications

Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy

Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy

Hypertension in HIV-Infected Patients Receiving Antiretroviral Therapy in Northeast Ethiopia

Epidemiology of Non-communicable Diseases and Risk factors in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention

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