Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults

Ryscavage, Patrick; Still, William; Nyemba, Vimbai; Stafford, Kristen A.

doi:10.1093/ofid/ofx162.138

Cited by 8 publications

(5 citation statements)

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“…Although the epidemiologic problem of hypertension in HIV-infected adults is well defined, 6,7,9 fewer studies have evaluated the pathophysiologic mechanisms leading to hypertension in PLWH. Traditional cardiovascular risk factors explain some, but not all, of the increased hypertension risk among HIV-infected adults.…”

Section: Introductionmentioning

confidence: 99%

Hypertension in HIV-Infected Adults

2018

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Section: Introductionmentioning

confidence: 99%

Hypertension in HIV-Infected Adults

2018

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“…We therefore used Hazard ratios (HR) from the univariate and multivariable cox proportional hazards models to determine the predictors of time to first BP control at a 5% significance level. In our models, we included covariates known to influence blood pressure i.e., age, sex, BMI, smoking, immunological status (viral load suppression and CD4+ cell count) as well as ART regimens and duration on ART[ 19 – 21 ]…”

Section: Methodsmentioning

confidence: 99%

Time to blood pressure control and predictors among patients receiving integrated treatment for hypertension and HIV based on an adapted WHO HEARTS implementation strategy at a large urban HIV clinic in Uganda

Amutuhaire,

Semitala,

Kimera

et al. 2024

J Hum Hypertens

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In this cohort study, we determined time to blood pressure (BP) control and its predictors among hypertensive PLHIV enrolled in integrated hypertension-HIV care based on the World Health Organization (WHO) HEARTS strategy at Mulago Immunosuppression Clinic in Uganda. From August 2019 to March 2020, we enrolled hypertensive PLHIV aged $$\ge$$ ≥ 18 years and initiated Amlodipine 5 mg mono-therapy for BP (140–159)/(90–99) mmHg or Amlodipine 5 mg/Valsartan 80 mg duo-therapy for BP ≥ 160/90 mmHg. Patients were followed with a treatment escalation plan until BP control, defined as BP < 140/90 mmHg. We used Cox proportional hazards models to identify predictors of time to BP control. Of 877 PLHIV enrolled (mean age 50.4 years, 62.1% female), 30% received mono-therapy and 70% received duo-therapy. In the monotherapy group, 66%, 88% and 96% attained BP control in the first, second and third months, respectively. For patients on duo-therapy, 56%, 83%, 88% and 90% achieved BP control in the first, second, third, and fourth months, respectively. In adjusted Cox proportional hazard analysis, higher systolic BP (aHR 0.995, 95% CI 0.989-0.999) and baseline ART tenofovir/lamivudine/efavirenz (aHR 0.764, 95% CI 0.637–0.917) were associated with longer time to BP control, while being on ART for >10 years was associated with a shorter time to BP control (aHR 1.456, 95% CI 1.126–1.883). The WHO HEARTS strategy was effective at achieving timely BP control among PLHIV. Additionally, monotherapy anti-hypertensive treatment for stage I hypertension is a viable option to achieve BP control and limit pill burden in resource limited HIV care settings.

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“…Youths living with HIV is a high-priority population within those living with HIV [1]. Youths living with HIV will need to manage their diagnosis for years longer than their adult peers, and negative health consequences associated with living with HIV may appear earlier in the life course [2][3][4][5][6]. Research shows significant gaps in the HIV treatment cascade in younger populations compared to older groups [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Risk Assessment Among Adolescents and Youths Living With HIV: Evaluation of Electronic Health Record Findings and Implications

et al. 2023

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Background The HIV epidemic remains a major public health concern, particularly among youths living with HIV. While the availability of antiretroviral therapy has significantly improved the health outcomes of people living with HIV, there is growing evidence that youths living with HIV may be at increased risk of cardiovascular disease. However, the underlying mechanisms linking HIV and cardiovascular disease among youths living with HIV remain poorly understood. One potential explanation is that HIV-related biomarkers, including detectable viral load (VL) and low cluster of differentiation 4 (CD4) lymphocyte counts, may contribute to increased cardiovascular risk. Despite the potential importance of these biomarkers, the relationship between HIV-related biomarkers and cardiovascular risk among youths living with HIV has been understudied. Objective To address this gap, we examined whether detectable VL and low CD4 lymphocyte counts, both of which are indications of unsuppressed HIV, were associated with cardiovascular risk among youths living with HIV. Methods We analyzed electronic health record data from 7 adolescent HIV clinics in the United States (813 youths living with HIV). We used multivariable linear regression to examine the relationship between detectable VL and CD4 lymphocyte counts of ≤200 and cardiovascular risk scores, which were adapted from the gender-specific Framingham algorithm. Results In our study, nearly half of the participants (366/766, 47.8%) had detectable VL, indicating unsuppressed HIV, while 8.6% (51/593) of them had CD4 lymphocyte counts of ≤200, suggesting weakened immune function. We found that those with CD4 lymphocyte counts of ≤200 had significantly higher cardiovascular risk, as assessed by Cardiac Risk Score2, than those with CD4 lymphocyte counts of >200 (P=.002). After adjusting for demographic and clinical factors, we found that for every 1000-point increase in VL copies/mL, the probability of having cardiovascular risk (Cardiac Risk Score2) increased by 38%. When measuring the strength of this connection, we observed a minor effect of VL on increased cardiovascular risk (β=.134, SE 0.014; P=.006). We obtained similar results with Cardiac Risk Score1, but the effect of CD4 lymphocyte counts of ≤200 was no longer significant. Overall, our findings suggest that detectable VL is associated with increased cardiovascular risk among youths living with HIV, and that CD4 lymphocyte counts may play a role in this relationship as well. Conclusions Our study highlights a significant association between unsuppressed HIV, indicated by detectable VL, and increased cardiovascular risk in youths living with HIV. These findings emphasize the importance of implementing interventions that address both VL suppression and cardiovascular risk reduction in this population. By tailoring interventions to meet the unique needs of youths, we can promote overall well-being throughout the HIV care continuum and across the life span. Ultimately, these efforts have the potential to improve the health outcomes and quality of life of youths living with HIV. International Registered Report Identifier (IRRID) RR2-10.2196/11185

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Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults

Cited by 8 publications

References 0 publications

Hypertension in HIV-Infected Adults

Hypertension in HIV-Infected Adults

Time to blood pressure control and predictors among patients receiving integrated treatment for hypertension and HIV based on an adapted WHO HEARTS implementation strategy at a large urban HIV clinic in Uganda

Cardiovascular Risk Assessment Among Adolescents and Youths Living With HIV: Evaluation of Electronic Health Record Findings and Implications

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