Immune Activation and Risk of Hypertension in HIV-Infected Adults Initiating Antiretroviral Therapy in Uganda: A Nested Case-Control Study
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Immune activation and inflammation are associated with risk of atherosclerosis among people living with HIV. It is not clear whether these factors also correlate with risk of hypertension. Methods. We conducted a nested case-control study within a cohort in southwestern Uganda to detect associations between pre-ART immune activation and incident hypertension. Blood testing for CD4 count and plasma biomarkers (lipopolysaccharide, soluble CD14, soluble CD163, lnterleukin-6, kynurenine/tryptophan [K/T] ratio, and D-dimer were conducted at ART initiation and 6 months after. Participants had blood pressure measurements at each clinic visit. We defined a case as presence of systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mmHg on at least 3 consecutive visits after ART initiation. Controls were participants with a minimum of 3 visits and no elevated blood pressure readings after ART initiation. We used logistic regression to identify correlates of incident hypertension, with each interquartile range (IQR) increase in biomarker concentrations at ART initiation and 6 months after ART. Models were adjusted for traditional cardiovascular risk factors and pre-ART CD4 counts. Results. We identified 89 cases and 167 controls with a median follow up of 2.3 years after ART initiation; median age was 34 years. Male gender (AOR = 2.36; 95% CI, 1.03–1.11; P = .008), increasing age (AOR = 1.07; 95% CI, 1.25–4.47; P < .001), obesity (AOR = 9.80; 95% CI, 1.87–51.3; P = .007), and nadir CD4 cell count (<250 cells) (AOR = 1.51; 95% CI, 0.27–0.98; P = .042) were associated with incident hypertension. Each IQR increase in D-dimer levels at ART initiation (AOR = 0.82; 95% CI, 0.45–1.48; P = .057) and at 6 months (AOR = 0.69; 95% CI, 0.35–1.34; P = .023) was associated with decreased risk of incident hypertension. Although not statistically significant, similar associations were seen for sCD14 and K/T ratio. Conclusion. Among HIV-infected patients receiving ART in Uganda, increases in D-dimer, K/T ratio, and sCD14 were inversely correlated with incident hypertension. These results are in keeping with prior studies suggesting that hypertension risk among people with HIV is associated with traditional risk factors, and less so with HIV-associated inflammation. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2234069529