Hypertension Risk Factors in Young Adults With Perinatal HIV Infection

The risk for hypertension among adults with perinatal HIV infection does not appear to be increased by most traditional or HIV-related risk factors, according to results of a study published in HIV Medicine.

Investigators conducted a case-control study among adults aged 18 to 30 years with perinatal HIV infection hospitalized at the University of Maryland Medical Center. Traditional risk factors for hypertension including age, family history, and smoking history, as well as HIV-related risk factors such as CD4 cell count nadir were assessed.

Among a total of 160 patients included in the study, 49 (30.6%) met the criteria for hypertension and were classified as cases and 111 were classified as controls. Of the 49 patients who met the inclusion criteria, 20 (40.8%) had a documented prescription for antihypertensive medications.

The researchers found no significant differences between patients in either group in terms of age, ethnicity, sex, alcohol use, tobacco use, or documented first-degree family history of hypertension. Of note, there was a significantly decreased number of patients with a history of chronic kidney disease (CKD) in the cases group vs the control group (16 vs 11; P =.0004). In terms of HIV-related risk factors, exposure to lopinavir/ritonavir was significantly more likely among patients in the control group vs those in the cases group (59 vs 16; P =.005).

The researchers noted that the odds having a history of CKD or a CD4 nadir count of greater than or equal to 200 cells/μL were decreased among patients in the cases group (odds ratio [OR], 4.32; 95% CI, 1.46-12.79) vs those in the control group (OR, 2.31; 95% CI, 0.92-5.81). In addition, prior exposure to lopinavir/ritonavir was found to be associated with a significantly decreased risk for hypertension (adjusted OR, 0.20; 95%, CI 0.08-0.53).

This study was limited by its retrospective design and single-center setting. In addition, many patients had 1 or more deceased parents, increasing the risk for misclassification of family history of hypertension. Finally, the definition of hypertension was chosen to match similar studies but under this definition it is possible that patients who met criteria for hypertension had only transient increased blood pressure, which may have subsequently normalized.

According to the researchers, “as increasing global numbers of [patients with perinatal HIV infection] age into adulthood, the risk for chronic nonAIDS disease burden may continue to grow.” In addition, “further research should prospectively examine the interplay of chronic HIV disease and antiretroviral burden on systemic hypertension among [patients with perinatal HIV infection],” the researchers concluded.

Reference

O’Neil PJ, Stafford KA, Ryscavage PA. Assessing risk factors for hypertension in young adults with perinatally acquired HIV infection: A case–control study. HIV Med. 2021;00:1–8. doi:10.1111/hiv.13199