Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV

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 life-style 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.

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

“…The strongest demographic/metabolic predictors of hypertension in our study were male gender, older age, black African ethnicity, diabetes, dyslipidaemia, use of LLDs, a high BMI and a low eGFR, consistent with previous findings [12][13][14][15][16]. Current or previous smoking was not found to be a predictor; although smoking is an important risk factor for arteriosclerosis and can cause arterial stiffness which could lead to hypertension, there is limited evidence of a direct causal relationship between smoking and hypertension [39].…”

“…The prevalence of hypertension is higher in HIV-positive than HIV-negative individuals [10,11], and is increasing [12]. Hypertension in HIV-positive individuals has been linked to traditional CVD risk factors such as diabetes, renal impairment, older age, male gender, black African ethnicity, dyslipidaemia and high body mass index (BMI) [12][13][14][15][16]. Furthermore, factors related to HIV infection, such as immunosuppression, inflammation, increased arterial stiffness, fat redistribution and lipodystrophy, may also contribute to an increased risk of hypertension [17][18][19][20].…”

New Drugs for NASH and HIV Infection: Great Expectations for a Great Need

“…This immuno‐metabolic phenomenon is often described as “inflammaging” ( 17 ) and is pathogenically linked with metabolic syndrome, ( 18 ) NICM, ( 19 ) functional decline, ( 20 ) and geriatric syndromes. ( 21 ) In this context, both NAFLD and HIV infection are multisystemic diseases affecting multiple organs that are associated with increased risk of age‐related NICMs, including type 2 diabetes mellitus, cardiovascular disease, and chronic kidney disease.…”

TLR4-Mediated Inflammation Promotes KSHV-Induced Cellular Transformation and Tumorigenesis by Activating the STAT3 Pathway

“…Moreover, metabolic syndrome is commonly observed in AIDS patients and associated with high levels of fatty acids in the sera, which could activate the TLR4 pathway (17). In this study, we aim to determine whether persistent TLR4 activation contributes to KSHV-induced inflammation and cellular transformation.…”