Impact of highly active antiretroviral therapy on blood pressure in HIV‐infected patients. A prospective study in a cohort of naive patients

Palacios, Rosario; Santos, Jesús; García, Alberto Titos; Castells, E; González, Mercedes; Ruiz, Josefa; Márquez, Manuel

doi:10.1111/j.1468-1293.2005.00333.x

Cited by 128 publications

(128 citation statements)

References 32 publications

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“…Diabetes mellitus was associated with a lower hazard of ICH, as were statin and antiplatelet use. We observed an interaction between female sex and HIV status on the hazard of ICH, with a protective effect of female sex on ICH in HIV-uninfected individuals, but an estimate of no protective effect among those with HIV ( Several risk factors for ICH are more prevalent in HIV-infected individuals than in the general population, including hypertension, [13][14][15][16] a strong independent predictor of ICH. [17][18][19][20][21] Moreover, at younger ages, African Americans, who have been disproportionately affected by the HIV epidemic, 22 have a greater risk of ICH compared with whites.…”

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confidence: 88%

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Chow

Bacchetti

et al. 2014

Neurology

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Objective: To compare rates of intracerebral hemorrhage (ICH) in HIV-infected and uninfected individuals in a large clinical care cohort and to assess risk factors associated with ICH. Methods:We identified incident ICH in HIV-infected and uninfected control cohorts from the Partners Health Care system using ICD-9-CM codes. We constructed Cox proportional hazards models to estimate adjusted hazard ratios for HIV infection and other predictors of ICH.Results: The incidence rate of ICH was 2.29 per 1,000 person-years in HIV-infected individuals compared with 1.23 per 1,000 person-years in uninfected individuals, with an unadjusted incidence rate ratio of 1.85 (95% confidence interval 1.37-2.47, p , 0.001). In a multivariable model, HIV infection was independently associated with a higher hazard of ICH, although its effect diminished with increasing age. Female sex was associated with a lower hazard of ICH in the uninfected cohort but not in the HIV cohort. CD4 count ,200 3 10 6 cells/L and anticoagulant use were predictive of ICH.Conclusions: HIV infection conferred an increased adjusted hazard of ICH, which was more pronounced in young patients and in women. Cardiovascular and cerebrovascular event rates are increased in HIV infection. [1][2][3][4][5][6][7] Several studies pointing to an elevated risk of cerebrovascular disease in HIV-infected individuals have focused on ischemic stroke and excluded intracranial hemorrhage. 5,8,9 Whereas ischemic stroke and cardiovascular disease often coexist and share a similar risk profile and underlying mechanism, the association between HIV and intracerebral hemorrhage (ICH), which has mechanisms distinct from ischemic stroke, is less clear. We examined the association of HIV with the risk of ICH by comparing the incidence of ICH in HIV-infected and uninfected individuals in a large US clinical care cohort. Our primary hypothesis was that the rate of ICH in HIV-infected individuals would be higher than in uninfected individuals. We further controlled for potential confounders and identified predictors of ICH in HIV-infected individuals.METHODS Study design and patient population. We conducted an observational study of an HIV cohort derived from the Partners HealthCare System Research Patient Data Registry (RPDR), a clinical care database of all inpatient and outpatient encounters from Massachusetts General Hospital and Brigham and Women's Hospital. Other vascular outcomes have been studied in this cohort.3,5 HIV-infected individuals were identified from the RPDR using ICD-9-CM codes 042 or V08, previously validated in the cohort. 5 The HIV cohort was matched by age, race, and sex in a 1:10 ratio to HIV-uninfected individuals, who constituted the control cohort. The control cohort was intentionally overpopulated to allow for the possibility of missing data and application of the exclusion criteria. Within the cohorts, individuals who were at least 18 years of age at the beginning of the observation period and who had at least 1 inpatient or 2 outpatient clinical encou...

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confidence: 88%

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Chow

Bacchetti

et al. 2014

Neurology

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“…Regarding the evidence levels, the following distribution was observed: four on level IV (10,16,20,23) ; three on level V (21)(22)24) ; and ten on level VI (11)(12)(13)(14)(15)(16)(17)(18)(19)(25)(26) .…”

Section: Resultsmentioning

confidence: 99%

“…The characterization of the 17 articles showed the year of publication varied between 2001 and 2016, with six articles published in Brazil (10)(11)(12)(13)(14)(15) , five in the United States (16)(17)(18)(19)(20) , four in European countries (21)(22)(23)(24) , one article in Cameroon (25) and one in Chile (26) . Regarding the evidence levels, the following distribution was observed: four on level IV (10,16,20,23) ; three on level V (21)(22)24) ; and ten on level VI (11)(12)(13)(14)(15)(16)(17)(18)(19)(25)(26) .…”

Section: Resultsmentioning

confidence: 99%

Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review

et al. 2017

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Objective: To analyze scientific productions about the relationship between HIV and Systemic Arterial Hypertension (SAH) in people living with HIV/AIDS (PLWHA). Method: Integrative literature review in six databases, held in March 2016. “AIDS” and “hypertension” were the keywords used in Portuguese, English and Spanish languages. We found 248 articles and selected 17. The categories formulated were “prevalence of SAH in PLWHA,” “risk factors for SAH in PLWHA” and “adverse events of antiretroviral therapy (ART) that contribute to HAS.” Results: There is no consensus whether HIV and ART influence the SAH development, but there are several risk factors for SAH among PLWHA. It was observed that protease inhibitors medicines influence SAH the most. Conclusion: Guidelines for SAH prevention must be performed in all individuals, however, in PLWHA, they must focus on characteristic risk factors of this population.

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“…1). 6,13,14 Em algumas casuísticas de doentes infetados, a hipertensão arterial tem surgido como mais prevalente do que nos grupos controlo, [15][16][17][18] relacionando-se com o índice de massa corporal, a idade, o sexo, o perfil lipídico, a distribuição da gordura corporal e a insulinorresistência. [18][19][20] A duração da terapia antirretrovírica combinada e o tipo de esquema terapêutico adotado parecem também influenciar a probabilidade de desenvolver hipertensão.…”

Section: Estado Pró-ateroscleróticounclassified

Aterosclerose Precoce na População Pediátrica Infetada pelo VIH: Revisão da Literatura e Abordagem Clínica

et al. 2017

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RESUMOAs crianças e adolescentes infetados pelo vírus da imunodeficiência humana representam um grupo pediátrico com risco acrescido de doença cardiovascular precoce. O próprio vírus, a terapêutica antirretrovírica e os estilos de vida estabelecem um complexo conjunto interatuante de fatores que promove a aterosclerose acelerada. Este processo é provavelmente mediado por dislipidémia, alterações do metabolismo glicídico, inflamação crónica com disfunção endotelial e um estado pro-trombótico. A abordagem clínica desta população para prevenção cardiovascular é baseada sobretudo num tratamento eficaz da infeção, na redução dos fatores de risco modificáveis e na promoção de hábitos saudáveis. INTRODUÇÃOO processo aterosclerótico inicia-se no feto e progride lentamente ao longo da vida, sendo responsável por cerca de 50% da mortalidade nos países europeus. 1 Na população infetada com vírus da imunodeficiência humana (VIH), a aterosclerose ocorre de uma forma acelerada, podendo aumentar a morbilidade e diminuir a sobrevida deste grupo. De facto, o risco de enfarte agudo do miocárdio é 50% superior nos seropositivos, quando comparados com a população em geral, mesmo após efectuado o ajuste para os outros fatores de risco cardiovasculares contemplados no score de Framingham. 2 A incidência de acidente vascular cerebral também é mais elevada nos doentes infetados, como comprovado por Marcus et al (2014), sobretudo se tiverem uma elevada carga vírica e/ ou uma baixa contagem de células CD4, 3 correspondendo a uma fase avançada da doença.Nas crianças e adolescentes infetados, o leito vascular arterial exibe precocemente alterações estruturais e funcionais próprias de aterosclerose sub-clínica.4-10 Múltiplos fatores parecem convergir para propiciar um meio pró-aterosclerótico no contexto da infeção VIH. Reconhecer esta realidade é indispensável para um correcto acompanhamento destes doentes em idade pediátrica, evitando complicações cardiovasculares futuras. Estado pró-ateroscleróticoMuita da informação existente sobre o processo aterosclerótico no contexto da infeção VIH provém de estudos efectuados em adultos. No entanto, os dados científicos disponíveis relativos à população pediátrica, aponta para mecanismos pró-ateroscleróticos idênticos, ainda que as manifestações clínicas escasseiem nesta faixa etária.Na população infetada parece haver uma maior prevalência dos fatores de risco cardiovascular 'clássicos' como o tabagismo, 11,12 a hipertensão arterial, a dislipidémia, a insulinorresistência e/ou diabetes. Este predomínio de fatores de risco é só parcialmente justificado pelos estilos de vida e pela genética, desempenhando provavelmente a infeção crónica e a terapêutica antirretroviral uma influência preponderante (Fig. 1). 6,13,14 Em algumas casuísticas de doentes infetados, a hipertensão arterial tem surgido como mais prevalente do que nos grupos controlo, 15-18 relacionando-se com o índice de massa corporal, a idade, o sexo, o perfil lipídico, a distribuição da gordura corporal e a insulinorresistência.18-20 A dura...

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Impact of highly active antiretroviral therapy on blood pressure in HIV‐infected patients. A prospective study in a cohort of naive patients

Cited by 128 publications

References 32 publications

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review

Aterosclerose Precoce na População Pediátrica Infetada pelo VIH: Revisão da Literatura e Abordagem Clínica

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