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Prevalence of Hypertension in HIV-Positive Patients on Highly Active Retroviral Therapy (HAART) Compared with HAART-Naïve and HIV-Negative Controls: Results from a Norwegian Study of 721 Patients

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Abstract

Highly active antiretroviral therapy (HAART) may induce dyslipidemia, insulin resistance and body fat distribution similar to that seen in the metabolic syndrome. Hypertension is often a part of the classic metabolic syndrome, but few studies are published about hypertension in HIV-positive patients on HAART. The aim of this study was to compare the prevalence of hypertension in HIV-positive patients on HAART with that in HIV-positive/HAART-naïve patients and HIV-negative controls. The cross-sectional study included 283 unselected HIV-positive ambulatory patients, 219 who were on HAART and 64 who were HAART-naïve. Age- and gender-matched controls (n=438) were randomly selected from a simultaneous health survey of the general population. The prevalence of hypertension was 21% in patients on HAART, 13% in HAART-naïve patients (P=0.20), and 24% in HIV-negative controls (P=0.28). Among several possible risk factors for hypertension, only body mass index (BMI) was found to be a confounder. BMI was similar in HAART-treated and HAART-naïve patients but elevated in controls compared to HAART-treated patients. After adjustment for BMI, the prevalence of hypertension in HIV-negative controls was slightly lower than that in patients on HAART (P=0.29). The results demonstrated a prevalence of hypertension in patients on HAART similar to that in HIV-negative controls. The prevalence of hypertension was somewhat higher in patients on HAART compared to HAART-naïve patients, but the difference was not statistically significant. Considering the marked drop in mortality following antiretroviral therapy, we conclude that the possible influence of HAART on the prevalence of hypertension appears to be a minor problem.

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References

  1. Carr A, Cooper DA (1998) Images in clinical medicine. Lipodystrophy associated with an HIV-protease inhibitor. N Engl J Med 339:1296

    CAS  PubMed  Google Scholar 

  2. Mulligan K, Grunfeld C, Tai VW, Algren H, Pang M, Chernoff DN, et al (2000) Hyperlipidemia and insulin resistance are induced by protease inhibitors independent of changes in body composition in patients with HIV infection. J Acquir Immune Defic Syndr 23:35–43

    CAS  PubMed  Google Scholar 

  3. Safrin S, Grunfeld C (1999) Fat distribution and metabolic changes in patients with HIV infection. AIDS 13:2493–2505

    CAS  PubMed  Google Scholar 

  4. World Health Organisation (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Document no. WHO/NCD/NCS/99.2. WHO, Geneva, pp 31–32

    Google Scholar 

  5. Hauner H (2002) Insulin resistance and the metabolic syndrome: a challenge of the new millennium. Eur J Clin Nutr 56 [Suppl 1]:25–29

    Google Scholar 

  6. Passalaris JD, Sepkowitz KA, Glesby MJ (2000) Coronary artery disease and human immunodeficiency virus infection. Clin Infect Dis 31:787–797

    CAS  PubMed  Google Scholar 

  7. Henry K, Melroe H, Huebsch J, Hermundson J, Levine C, Swensen L, et al (1998) Severe premature coronary artery disease with protease inhibitors. Lancet 351:1328

    CAS  Google Scholar 

  8. Maggi P, Fiorentino G, Epifani G, Ladisa N, Lillo A, Perilli F, et al (2002) Premature vascular lesions in HIV-positive patients: a clockwork bomb that will explode? AIDS 16:947–948

    PubMed  Google Scholar 

  9. Barbaro G, Di Lorenzo G, Giancaspro GPAM, Grisorio B (2002) Incidence of coronary artery disease in HIV-infected patients receiving or not protease inhibitors: a randomized, multicenter trial. In: Program and Abstracts of the XIV International AIDS Conference, abstract no. WeOrB-1307

  10. Depairon M, Chessex S, Sudre P, Rodondi N, Doser N, Chave JP, et al (2001) Premature atherosclerosis in HIV-infected individuals – focus on protease inhibitor therapy. AIDS 15:329–334

    CAS  PubMed  Google Scholar 

  11. Foster DW (1991) The lipodystrophies and other rare disorders of adipose tissue. In: Wilson JD, Braunwald E, Isselbacher KJ, Petersdorf RG, Martin JB, Fauci AS, Root RK (eds) Harrison’s principles of internal medicine, 12th edn. McGraw-Hill, New York, pp 1883–1887

  12. Galindo Puerto MJ (2002) AHT and HIV – a new problem? Nutr Metab Disord HIV Infect 1:33–37

    Google Scholar 

  13. Cattelan AM, Trevenzoli M, Sasset L, Rinaldi L, Balasso V, Cadrobbi P (2001) Indinavir and systemic hypertension. AIDS 15:805–807

    CAS  PubMed  Google Scholar 

  14. Sattler FR, Qian D, Louie S, Johnson D, Briggs W, DeQuattro V, et al (2001) Elevated blood pressure in subjects with lipodystrophy. AIDS 15:2001–2010

    CAS  PubMed  Google Scholar 

  15. Gazzaruso C, Bruno R, Garzaniti A, Giordanetti S, Fratino P, Sacchi P, et al (2003) Hypertension among HIV patients: prevalence and relationships to insulin resistance and metabolic syndrome. J Hypertens 21:1377–1382

    CAS  PubMed  Google Scholar 

  16. Aoun S, Ramos E (2000) Hypertension in the HIV-infected patient. Curr Hypertens Rep 2:478–481

    CAS  PubMed  Google Scholar 

  17. Grøntveit L (2002) Health profile for adults in Oslo. National Health Screening Service, Oslo

  18. Hypertension prevalence and the status of awareness, treatment, and control in the United States (1985) Final report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee. Hypertension 7 (Pt 1):457–468

    PubMed  Google Scholar 

  19. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419

    CAS  PubMed  Google Scholar 

  20. Kramer MS (1991) Confounding bias. Clinical epidemiology and biostatistics, a primer for clinical investigators and decision-makers. Springer-Verlag, Berlin, p 53

  21. Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al (1995) Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 25:305–313

    CAS  PubMed  Google Scholar 

  22. Friis-Moller N, Weber R, Reiss P, Thiebaut R, Kirk O, D’Arminio MA, et al (2003) Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the DAD study. AIDS 17:1179–1193

    PubMed  Google Scholar 

  23. Kotler DP, Rosenbaum K, Wang J, Pierson RN (1999) Studies of body composition and fat distribution in HIV-infected and control subjects. J Acquir Immune Defic Syndr Hum Retrovirol 20:228–237

    CAS  PubMed  Google Scholar 

  24. Sullivan AK, Nelson MR (1997) Marked hyperlipidaemia on ritonavir therapy. AIDS 11:938–939

    CAS  PubMed  Google Scholar 

  25. Periard D, Telenti A, Sudre P, Cheseaux JJ, Halfon P, Reymond MJ, et al (1999) Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors. The Swiss HIV Cohort Study. Circulation 100:700–705

    PubMed  Google Scholar 

  26. Mooser V, Carr A (2001) Antiretroviral therapy-associated hyperlipidaemia in HIV disease. Curr Opin Lipidol 12:313–319

    CAS  PubMed  Google Scholar 

  27. Behrens G, Dejam A, Schmidt H, Balks HJ, Brabant G, Korner T, et al (1999) Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. AIDS 13:F63–F70

    CAS  PubMed  Google Scholar 

  28. Noor MA, Seneviratne T, Aweeka FT, Lo JC, Schwarz JM, Mulligan K, et al (2002) Indinavir acutely inhibits insulin-stimulated glucose disposal in humans: a randomized, placebo-controlled study. AIDS 16:F1–F8

    PubMed  Google Scholar 

  29. Beckman JA, Creager MA, Libby P (2002) Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 287:2570–2581

    CAS  PubMed  Google Scholar 

  30. McComsey GA, Yao LK, O’Riordan M, Lederman MM, Valdez H, Gripshover B, Rodriguez B, et al (2002) Lack of significant changes in blood pressure of HIV+ subjects, even after long-term use of PI therapy. In: Abstracts of the XIV International AIDS Conference, abstract no. B-10302

  31. Chow D, Souza S, Richmond-Crum S, Shikuma C (2000) Epidemiological evidence of increasing blood pressure in HIV-1-infected individuals in the era of HAART. Antivir Ther 2000 5 [Suppl 5]:31–32

  32. Mattana J, Siegal FP, Sankaran RT, Singhal PC (1999) Absence of age-related increase in systolic blood pressure in ambulatory patients with HIV infection. Am J Med Sci 317:232–237

    CAS  PubMed  Google Scholar 

  33. Cohen JA, Miller L, Polish L (1991) Orthostatic hypotension in human immunodeficiency virus infection may be the result of generalized autonomic nervous system dysfunction. J Acquir Immune Defic Syndr 4:31–33

    CAS  PubMed  Google Scholar 

  34. Brownley KA, Milanovich JR, Motivala SJ, Schneiderman N, Fillion L, Graves JA, et al (2001) Autonomic and cardiovascular function in HIV spectrum disease: early indications of cardiac pathophysiology. Clin Auton Res 11:319–326

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank Anne Johanne Søgaard for valuable comments of the manuscript.

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Correspondence to B. M. Bergersen.

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Bergersen, B.M., Sandvik, L., Dunlop, O. et al. Prevalence of Hypertension in HIV-Positive Patients on Highly Active Retroviral Therapy (HAART) Compared with HAART-Naïve and HIV-Negative Controls: Results from a Norwegian Study of 721 Patients. Eur J Clin Microbiol Infect Dis 22, 731–736 (2003). https://doi.org/10.1007/s10096-003-1034-z

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