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Higher Prevalence of Hypertension in HIV-1-Infected Patients on Combination Antiretroviral Therapy Is Associated With Changes in Body Composition and Prior Stavudine Exposure
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Clinical Infectious Diseases 03 May 2016
Abstract
Background. Individuals infected with human immunodeficiency virus (HIV) have a higher risk of cardiovascular disease, potentially partly mediated by a higher prevalence of hypertension. We therefore examined the prevalence and determinants of hypertension in HIV-1-infected patients compared with appropriate HIV-negative controls.
Methods. Data from 527 HIV-1-infected and 517 HIV-uninfected participants at the time of enrollment into the ongoing AGEhIV Cohort Study were analyzed. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or self-reported use of antihypertensive drugs.
Results. Hypertension prevalence was higher among HIV-1-infected individuals compared with controls (48.2% vs 36.4%; odds ratio [OR], 1.63; 95% confidence interval [CI], 1.27-2.09). In logistic regression models adjusted for age, sex, ethnicity, family history of hypertension, smoking, alcohol use, physical activity, and body mass index, the association between HIV and hypertension remained statistically significant (ORHIV, 1.65; 95% CI, 1.25-2.19), but was attenuated after additional adjustment for waist-to-hip ratio (ORHIV, 1.29; 95% CI, .95-1.76). Among HIV-1-infected individuals, particularly among those with mono/dual nucleoside reverse transcriptase inhibitor therapy prior to combination antiretroviral therapy, stavudine exposure was independently associated with hypertension (ORstavudine, 1.54; 95% CI, 1.04-2.30). This association was attenuated after additional adjustment for either waist-to-hip ratio (ORstavudine, 1.30; 95% CI, .85-1.96) or hip circumference (ORstavudine, 1.40; 95% CI, .93-2.11).
Conclusions. Our findings suggest that changes in body composition, involving both abdominal obesity and stavudine-induced peripheral lipoatrophy, might contribute to the higher prevalence of hypertension in HIV-1-infected patients.
CONCLUSIONS
Hypertension is highly prevalent among predominantly virologically suppressed HIV-1-infected individuals. Unfavorable changes in body composition—that is, abdominal obesity among all HIV-1-infected individuals and lipoatrophy among those with prior exposure to stavudine—may contribute to the pathogenesis of the increased risk of hypertension among HIV-1-infected individuals. The contribution of lipoatrophy to the pathogenesis of hypertension may be expected to be largely absent in patients who initiated treatment with more contemporary cART regimens, which should no longer include stavudine. Yet, this might not be the case for HIV-1-infected patients in developing countries, where stavudine is still widely used because of cost considerations. Contemporary regimens may, however, continue to contribute to abdominal obesity. Hence, our results underline the importance of avoiding stavudine as well as limiting the occurrence of abdominal obesity in preventing and managing hypertension and cardiovascular risk among HIV-1-infected patients.
"Our results suggest a role for both abdominal fat accumulation and peripheral lipoatrophy in the pathophysiology of hypertension in the context of HIV. Whether abdominal obesity and HIV-associated lipohypertrophy share a common pathway in the development of hypertension is unclear. In the general population there is extensive evidence for the link between abdominal obesity and hypertension [28, 29].....We believe that our results are generalizable to other high-income settings with HIV epidemics driven by white men who have sex with men. However, as our cohort includes relatively few women and people of African descent, the extent to which our results can be generalized to other populations, such as populations in sub-Saharan Africa, remains to be determined."
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