Incidence of hypertension among persons living with HIV in China: a multicenter cohort study

Hongwei Fan, Fuping Guo, Evelyn Hsieh, Wei-Ti Chen, Wei Lv, Yang Han, Jing Xie, Yanling Li, Xiaojing Song, Taisheng Li, Hongwei Fan, Fuping Guo, Evelyn Hsieh, Wei-Ti Chen, Wei Lv, Yang Han, Jing Xie, Yanling Li, Xiaojing Song, Taisheng Li

Abstract

Background: Life expectancy among persons living with HIV (PLWH) has improved with increasing access to antiretroviral therapy (ART), however incidence of chronic comorbidities has simultaneously increased. No data are available regarding the incidence of hypertension among Chinese PLWH.

Methods: We analyzed data collected from patients enrolled in two prospective longitudinal multicenter studies of PLWH initiating ART in China. Incidence rate of hypertension per 100 person-years (PYs) among PLWH was calculated, and Cox proportional hazards models was used to evaluate the association between incident hypertension and traditional and HIV-associated risk factors.

Results: Of 1078 patients included in this analysis, 984 ART-naïve patients were hypertension-free at baseline, and contributed 2337.7 PYs of follow up, with a median follow-up period of 1.8 years (range: 1.2-3.2) after initiation of ART. Incidence of hypertension was 7.6 [95% confidence interval (CI): 6.5-8.7] per 100 PYs. In the Cox regression analysis, incidence of hypertension was positively associated with body mass index [adjusted hazard ratio (aHR) 1.07 (1.01,1.13), p = 0.02] and recent viral load (aHR 1.28, 95% CI:1.08-1.51, p < 0.01), and negatively associated with recent CD4+/CD8+ ratio (aHR 0.14, 95% CI:0.06-0.31, p < 0.001), zidovudine exposure (aHR 0.15, 95% CI: 0.10-0.24, p < 0.001) and tenofovir disoproxil fumarate exposure (aHR 0.13, 95% CI: 0.08-0.21, p < 0.001).

Conclusions: The incidence of hypertension was relatively high among Chinese PLWH initiating ART. Recent low CD4+/CD8+ ratio and detectable HIV viremia were associated with incident hypertension, whereas receipt of ART was associated with reduced risk. Hypertension may be mitigated, in part, by excellent HIV care, including viral suppression with ART.

Trial registration: ClinicalTrials.gov Identifier: NCT00872417 registered on 31 March, 2009, and NCT01844297 registered on 1 May, 2013.

Keywords: HIV; Hypertension; Incidence.

Conflict of interest statement

Dr. Hsieh has received honoraria from Gilead. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient flow chart. Abbreviation: CACT: China AIDS Clinical Trial
Fig. 2
Fig. 2
Kaplan-Meier survival estimates of incident hypertension. Abbreviations: ART, antiretroviral therapy; VL, HIV-1 viral load

References

    1. Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem A, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810–818.
    1. Armah KA, Chang CC, Baker JV, Ramachandran VS, Budoff MJ, Crane HM, et al. Prehypertension, hypertension, and the risk of acute myocardial infarction in HIV-infected and -uninfected veterans. Clin Infect Dis. 2014;58(1):121–129.
    1. Xu Y, Chen X, Wang K. Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. J Am Soc Hypertens. 2017;11(8):530–540.
    1. Manner IW, Baekken M, Oektedalen O, Os I. Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study. Blood Press. 2012;21(5):311–319.
    1. Krauskopf K, Van Natta ML, Danis RP, Gangaputra S, Ackatz L, Addessi A, et al. Correlates of hypertension in patients with AIDS in the era of highly active antiretroviral therapy. J Int Assoc Provid AIDS Care. 2013;12(5):325–333.
    1. De Socio GV, Ricci E, Maggi P, Parruti G, Celesia BM, Orofino G, et al. 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(2):409–416.
    1. Thiebaut R, El-Sadr WM, Friis-Moller N, Rickenbach M, Reiss P, Monforte AD, et al. Predictors of hypertension and changes of blood pressure in HIV-infected patients. Antivir Ther. 2005;10(7):811–823.
    1. Okeke NL, Davy T, Eron JJ, Napravnik S. Hypertension among HIV-infected patients in clinical care, 1996-2013. Clin Infect Dis. 2016;63(2):242–248.
    1. Wong C, Gange SJ, Buchacz K, Moore RD, Justice AC, Horberg MA, et al. First occurrence of diabetes, chronic kidney disease, and hypertension among north American HIV-infected adults, 2000-2013. Clin Infect Dis. 2017;64(4):459–467.
    1. Rodriguez-Arboli E, Mwamelo K, Kalinjuma AV, Furrer H, Hatz C, Tanner M, et al. Incidence and risk factors for hypertension among HIV patients in rural Tanzania - a prospective cohort study. PLoS One. 2017;12(3):e0172089.
    1. Okello S, Kanyesigye M, Muyindike WR, Annex BH, Hunt PW, Haneuse S, et al. Incidence and predictors of hypertension in adults with HIV-initiating antiretroviral therapy in South-Western Uganda. J Hypertens. 2015;33(10):2039–2045.
    1. Guo F, Hsieh E, Lv W, Han Y, Xie J, Li Y, et al. Cardiovascular disease risk among Chinese antiretroviral-naive adults with advanced HIV disease. BMC Infect Dis. 2017;17(1):287.
    1. Ding Y, Lin H, Liu X, Zhang Y, Wong FY, Sun YV, et al. Hypertension in HIV-infected adults compared with similar but uninfected adults in China: body mass index-dependent effects of nadir CD4 count. AIDS Res Hum Retrovir. 2017;33(11):1117–1125.
    1. Hejazi N, Huang MS, Lin KG, Choong LC. Hypertension among HIV-infected adults receiving highly active antiretroviral therapy (HAART) in Malaysia. Glob J Health Sci. 2013;6(2):58–71.
    1. Nduka CU, Stranges S, Sarki AM, Kimani PK, Uthman OA. 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. 2016;30(6):355–362.
    1. Li T, Guo F, Li Y, Zhang C, Han Y, Lye W, et al. An antiretroviral regimen containing 6 months of stavudine followed by long-term zidovudine for first-line HIV therapy is optimal in resource-limited settings: a prospective, multicenter study in China. Chin Med J. 2014;127(1):59–65.
    1. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research. Hypertension. 2005;45(1):142–161.
    1. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obesity research. 1998;6 Suppl 2:51S–209S.
    1. National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.
    1. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–612.
    1. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–735.
    1. van Zoest RA, van den Born BH, Reiss P. Hypertension in people living with HIV. Curr Opin HIV AIDS. 2017;12(6):513–522.
    1. Yang ZJ, Liu J, Ge JP, Chen L, Zhao ZG, Yang WY, et al. Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007-2008 China National Diabetes and metabolic disorders study. Eur Heart J. 2012;33(2):213–220.
    1. Liang Y, Liu R, Du S, Qiu C. Trends in incidence of hypertension in Chinese adults, 1991-2009: the China health and nutrition survey. Int J Cardiol. 2014;175(1):96–101.
    1. Carson AP, Howard G, Burke GL, Shea S, Levitan EB, Muntner P. Ethnic differences in hypertension incidence among middle-aged and older adults: the multi-ethnic study of atherosclerosis. Hypertension. 2011;57(6):1101–1107.
    1. Bruno G, Saracino A, Monno L, Angarano G. The revival of an "old" marker: CD4/CD8 ratio. AIDS Rev. 2017;19(2):81–88.
    1. Riddler SA, Aga E, Bosch RJ, Bastow B, Bedison M, Vagratian D, et al. Continued slow decay of the residual plasma Viremia level in HIV-1-infected adults receiving long-term antiretroviral therapy. J Infect Dis. 2016;213(4):556–560.
    1. Vassallo M, Durant J, Lebrun-Frenay C, Fabre R, Ticchioni M, Andersen S, et al. Virologically suppressed patients with asymptomatic and symptomatic HIV-associated neurocognitive disorders do not display the same pattern of immune activation. HIV Med. 2015;16(7):431–440.
    1. Sigel K, Wisnivesky J, Crothers K, Gordon K, Brown ST, Rimland D, et al. Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study. Lancet HIV. 2017;4(2):e67–e73.
    1. Triplette M, Attia EF, Akgun KM, Soo Hoo GW, Freiberg MS, Butt AA, et al. A low peripheral blood CD4/CD8 ratio is associated with pulmonary emphysema in HIV. PLoS One. 2017;12(1):e0170857.
    1. Trickey A, May MT, Schommers P, Tate J, Ingle SM, Guest JL, et al. CD4:CD8 ratio and CD8 count as prognostic markers for mortality in human immunodeficiency virus-infected patients on antiretroviral therapy: the antiretroviral therapy cohort collaboration (ART-CC) Clin Infect Dis. 2017;65(6):959–966.
    1. Menozzi M, Zona S, Santoro A, Carli F, Stentarelli C, Mussini C, et al. CD4/CD8 ratio is not predictive of multi-morbidity prevalence in HIV-infected patients but identify patients with higher CVD risk. J Int AIDS Soc. 2014;17(4 Suppl 3):19709.
    1. Serrano-Villar S, Moreno S, Fuentes-Ferrer M, Sanchez-Marcos C, Avila M, Sainz T, et al. The CD4:CD8 ratio is associated with markers of age-associated disease in virally suppressed HIV-infected patients with immunological recovery. HIV Med. 2014;15(1):40–49.
    1. Harrison DG, Guzik TJ, Lob HE, Madhur MS, Marvar PJ, Thabet SR, et al. Inflammation, immunity, and hypertension. Hypertension. 2011;57(2):132–140.
    1. van Zoest RA, Wit FW, Kooij KW, van der Valk M, Schouten J, Kootstra NA, et al. 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(2):205–213.
    1. Okello S, Asiimwe SB, Kanyesigye M, Muyindike WR, Boum Y, 2nd, Mwebesa BB, et al. 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. 2016;73(4):396–402.
    1. Manner IW, Baekken M, Kvale D, Oektedalen O, Pedersen M, Nielsen SD, et al. Markers of microbial translocation predict hypertension in HIV-infected individuals. HIV Med. 2013;14(6):354–361.
    1. Mazzuca P, Caruso A, Caccuri F. HIV-1 infection, microenvironment and endothelial cell dysfunction. New Microbiol. 2016;39(3):163–173.
    1. Piconi S, Parisotto S, Rizzardini G, Passerini S, Meraviglia P, Schiavini M, et al. Atherosclerosis is associated with multiple pathogenic mechanisms in HIV-infected antiretroviral-naive or treated individuals. AIDS. 2013;27(3):381–389.
    1. Konukoglu D, Uzun H. Endothelial dysfunction and hypertension. Adv Exp Med Biol. 2017;956:511–540.
    1. Crane HM, Van Rompaey SE, Kitahata MM. Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy. AIDS. 2006;20(7):1019–1026.
    1. Peck RN, Shedafa R, Kalluvya S, Downs JA, Todd J, Suthanthiran M, et al. Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study. BMC Med. 2014;12:125.
    1. Boccara F, Auclair M, Cohen A, Lefevre C, Prot M, Bastard JP, et al. HIV protease inhibitors activate the adipocyte renin angiotensin system. Antivir Ther. 2010;15(3):363–375.
    1. 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. J Am Soc Hypertens. 2015;9(5):351–357.
    1. Papparella I, Ceolotto G, Berto L, Cavalli M, Bova S, Cargnelli G, et al. Vitamin C prevents zidovudine-induced NAD(P)H oxidase activation and hypertension in the rat. Cardiovasc Res. 2007;73(2):432–438.
    1. Diaz CM, Segura ER, Luz PM, Clark JL, Ribeiro SR, De Boni R, et al. Traditional and HIV-specific risk factors for cardiovascular morbidity and mortality among HIV-infected adults in Brazil: a retrospective cohort study. BMC Infect Dis. 2016;16:376.

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