Assessing Risk Factors for Hypertension in Young Adults With Perinatally Acquired HIV Infection

A Case-Control Study

Patrick J. O'Neil; Kristen A. Stafford; Patrick A. Ryscavage


HIV Medicine. 2022;23(5):457-464. 

In This Article

Abstract and Introduction


Objectives: Although the risk of AIDS-associated diseases has declined dramatically with combination antiretroviral therapy (cART), the incidence rates of chronic non-AIDS-associated diseases in perinatally HIV-infected adults have risen and have not been well characterized. Both traditional and HIV-associated risk factors have been found to contribute to hypertension in non-perinatally HIV-infected adults; whether these same factors contribute to hypertension in perinatally infected adults is not known. The purpose of this study was to determine the socio-demographic, clinical, virological and immunological factors associated with systemic hypertension among a cohort of perinatally HIV-infected adolescents and young adults.

Methods: We conducted a case–control study among a population of adults aged 18–35 years with perinatally acquired HIV infection receiving care at the University of Maryland Medical Center. Covariates assessed included traditional risk factors such as age, family history of hypertension, and smoking, as well as numerous HIV- and antiretroviral-associated covariates, including CD4 nadir.

Results: Approximately 31% of the cohort met criteria for hypertension. There were no significant differences in the odds of most traditional or HIV-associated risk factors among perinatally HIV-infected adults with hypertension compared with those with no diagnosis of hypertension. Exposure to lopinavir/ritonavir was associated with greater odds of not having hypertension, while a concurrent diagnosis of chronic kidney disease (CKD) was associated with greater odds of having hypertension.

Conclusions: The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having hypertension in this cohort of individuals. The aetiology of hypertension in this population remains to be elucidated.


Since the introduction of combination antiretroviral therapy (ART) the risk of AIDS-associated disease among those living with HIV has declined dramatically.[1] At the same time those with chronic HIV disease appear to be at risk for the early development of non-AIDS-associated diseases.[2] This trend may be due in part to HIV-associated potentiation of immuno-inflammatory phenomena and immune exhaustion associated with normal biological mechanisms of ageing, as well as with ART toxicity and traditional risk factors such as tobacco use.[3]

One group that uniquely manifests these dynamics is adults with perinatally acquired HIV (PHIV), a population that has experienced chronic HIV disease and ART exposure in the context of childhood and adolescent growth and development. A recent study of 109 PHIV young adults in Baltimore demonstrated a high prevalence of hypertension (HTN) diagnoses (26.6%), and incidence increased significantly after reaching adulthood (≥ 18 years).[4] In a subsequent study, this prevalence was found to be significantly higher than a matched cohort of PHIV young adults as well as a matched cohort of non-HIV-infected young adults.[5]

Identified risk factors for hypertension in older HIV-infected patients fall largely into two groups. Traditional hypertension risk factors, including increased body mass index (BMI), older age, male gender and African American ethnicity have been identified to increase risk for hypertension diagnosis in HIV subjects in several studies.[6–16] In addition, HIV-associated risk factors, including time since HIV diagnosis, duration of ART and CD4 nadir, have been associated with hypertension in several studies, although these findings have not been consistent.[6,8,15,17,18] In non-HIV-infected children, risk factors for the development of hypertension include preterm birth, childhood/adolescent BMI, family history, first- and second-hand exposure to cigarette smoke, diabetes mellitus and lower socioeconomic status.[19–21] It is unclear how any of these risk factors interplay among younger HIV-infected patients, although pathological structural and functional changes of the vasculature are often already present during childhood in PHIV children.[22,23]

It is critical to determine the factors that contribute to the development of hypertension among PHIV. Poorly controlled hypertension has been associated with the development of cardiovascular disease (including coronary artery disease and congestive heart failure), stroke, kidney disease and overall mortality.[24–26] If hypertension is indeed emergent among ageing PHIV patients, early identification and treatment may forestall the development of these outcomes. The purpose of this study was to identify the socio-demographic, clinical, virological and immunological factors associated with systemic hypertension among a cohort of PHIV young adults aged ≥ 18 years.