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First-Line Antiretroviral Regimens and Risk of Incident Hypertension in People With HIV: A 15-Year Cohort Study

Year: 2026

Type: article

Abstract: Background: People with HIV (PWH) face a growing burden of cardiovascular disease. Integrase strand transfer inhibitors (INSTIs) have been linked to weight gain and possibly hypertension, but head-to-head data among contemporary regimens are scarce, and few studies analyze older and modern regimens together. We evaluated the incidence of hypertension in antiretroviral therapy (ART)-naive PWH initiating Spanish guidelines-recommended first-line regimens since 2009. Methods: This study evaluated a retrospective cohort of ART-naive adults initiating first-line regimens from 2009 to 2024, grouped into non-nucleoside reverse transcriptase inhibitor (NNRTI), INSTI, and boosted protease inhibitor (PI)-based classes. Incident hypertension was defined by a composite of clinical diagnosis, antihypertensive initiation, or 2 consecutive measurements ≥ 140/90 mmHg. Time to hypertension was analyzed using Kaplan-Meir methods and Cox regression, with a prespecified INSTI subanalysis. Results: = .005); INSTI-based ART was independently associated with higher risk than NNRTIs (adjusted HR 1.61; 95% CI 1.20-2.17). Within the INSTI subgroup (n = 437; incidence 7/100 person-years), 5-year cumulative hypertension ranged from 9% (EVG/c/FTC/TAF) to 37% (dolutegravir-based); dolutegravir-based regimens carried a >2-fold adjusted hazard versus EVG/c/FTC/TAF. Higher body mass index was independently predictive but did not abolish this signal. Conclusions: In ART-naive PWH, INSTI-based regimens were associated with a higher incidence of hypertension than NNRTI-based regimens, whereas the comparison with PI-based regimens was not statistically significant. Dolutegravir-containing regimens were independently associated with incident hypertension supporting systematic blood pressure surveillance and further comparative studies.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofag686