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HIV Independently Boosts Odds of Hypertension in Older HIV+/HIV- Cohort
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15th European AIDS Conference, October 21-24, 2015, Barcelona
Mark Mascolini
HIV infection independently inflated the odds of hypertension in a comparison of 527 HIV-positive and 517 HIV-negative older people in the Netherlands [1]. Higher waist circumference and stavudine-induced lipoatrophy at least partly explained the impact of HIV on chances of hypertension.
With heightened awareness of cardiovascular disease risk in people with HIV, more attention has turned to classic risk factors, such as hypertension. AGEhIV cohort investigators conducted this study to determine whether hypertension prevalence is higher in HIV-positive people than matched HIV-negative controls and to isolate risk factors for hypertension.
AGEhIV includes HIV-positive and negative people 45 or older in the Netherlands. The researchers select HIV-negative people so the HIV-negative group largely matches the HIV-positive group in age, gender, and ethnic origin. Everyone in the negative group has a confirmed negative HIV test. Participants make twice-yearly study visits. A published baseline analysis reported higher prevalence of hypertension, myocardial infarction, peripheral arterial disease, and impaired kidney function in the HIV group [2].
The hypertension analysis presented at the European AIDS Conference focused on 527 HIV-positive people and 517 HIV-negative people who had blood pressure measurements and completed a questionnaire. The AGEhIV team defined hypertension as blood pressure at or above 140/90 mm Hg or self-reported use of antihypertensives. Median age was similar in the HIV-positive and HIV-negative groups (52.9 and 52.2), while proportions of men were 88.6% and 85.5%, a nonsignificant difference (P = 0.133).
The HIV group included a significantly higher proportion of current smokers (32.1% versus 24.4%, P = 0.006) and blacks (12.1% versus 5.6%, P < 0.001), who typically have higher hypertension rates and earlier onset than whites. People with HIV also differed significantly from their HIV-negative counterparts in proportions physically active (44.2% versus 52.8%, P = 0.005), with cardiovascular disease (10.1% versus 5.2%, P = 0.003), with high waist-to-hip ratio (83.3% versus 62.7%, P < 0.001), and in waist circumference (93.6 versus 90.8 cm, P = 0.002) and hip circumference (96.3 versus 99.0 cm, P < 0.001).
Almost everyone in the HIV group (95%) had a viral load below 200 copies. While 20.1% had taken single or dual nucleosides before a triple combination, 37.2% took stavudine at some point. Almost one third (30.7%) had an AIDS diagnosis.
Waist-to-hip ratio was significantly lower (better) in HIV-negative people than in HIV-positive people not exposed to stavudine or mono-or-dual therapy as well as in those who were exposed to stavudine with or without mono/dual exposure..
Hypertension prevalence proved significantly higher in cohort members with than without HIV (48% versus 36%, P < 0.001). Prevalence of hypertension was significantly higher with than without HIV in the two youngest age clusters, 45 to 50 (38% versus 25%, P < 0.05) and 50 to 55 (43% versus 27%, P < 0.05).
Logistic regression analysis adjusted for age, sex, ethnicity, smoking, body mass index, physical activity, family history of hypertension, and heavy alcohol use determined that HIV infection independently predicted 65% higher odds of hypertension (odds ratio [OR] 1.65, P < 0.001). When researchers further adjusted that analysis for waist-to-hip ratio, HIV infection fell short of independently predicting hypertension (OR 1.29, P = 0.098). When the model adjusted for waist circumference and all variables except waist-to-hip ratio, HIV again proved an independent predictor of hypertension (OR 1.47, P = 0.009). And in a model that adjusted for hip circumference and all preceding variables except waist-to-hip ratio and waist circumference, HIV remained an independent predictor of hypertension (OR 1.57, P = 0.002).
When logistic regression analysis considered only people with HIV, prior stavudine use boosted the odds of hypertension 54% (OR 1.54, P = 0.034) after adjustment for age, sex, ethnicity, smoking, body mass index, physical activity, family history of hypertension, and heavy alcohol use. Separately adding waist circumference to that model had little impact on the association between prior stavudine and hypertension (OR 1.49, P = 0.048). But separately adding waist-to-hip ratio or hip circumference to the model rendered the association between stavudine and hypertension nonsignificant.
The AGEhIV team concluded that HIV infection is independently associated with hypertension in their older Netherlands cohort and that the impact of HIV may be at least partly mediated by stavudine-induced lipoatrophy and by increased waist circumference. The researchers suggested that "limiting the occurrence of abdominal obesity is important in preventing hypertension and reducing cardiovascular risk."
References
1. van Zoest RA, Wit FW, Kooij KW, et al. Increased prevalence of hypertension in HIV-infected patients, most with suppressed viraemia on combination antiretroviral therapy, is associated with changes in body composition. 15th European AIDS Conference, October 21-24, 2015, Barcelona. Abstract PS 1/2.
2. Schouten J, Wit FW, Stolte IG, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV Cohort Study. Clin Infect Dis. 2014;59:1787-1797. http://www.natap.org/2014/HIV/ClinInfectDis2014Schoutencid_ciu701%281%29.pdf
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