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

Disclosures

HIV Medicine. 2022;23(5):457-464. 

In This Article

Results

In all, 160 subjects were identified for inclusion in the study. Forty-nine (30.6%) met criteria for hypertension and were categorized as cases, while 111 did not meet hypertension criteria and were categorized as controls. Of the 49 cases, 20 (40.8%) had a documented prescription for antihypertensive medication(s). Among those who met hypertension criteria but were not on antihypertensive therapy, eight (27.6%) had a documented blood pressure of either SBP > 140 mmHg or DBP > 90 mmHg at the most recent visit. Baseline characteristics are shown in Table 1. The unadjusted and adjusted prevalence odds ratios are exhibited in Table 2.

Traditional Risk Factors

The median age of cases did not differ from controls (26 vs. 25 years, respectively, p = 0.12). Nineteen (39%) cases were male, while 48 (43%) controls were male (p = 0.34). Forty-seven (96%) cases and 105 (94%) controls were African American (p = 0.58). Nineteen (39%) cases were either current or former alcohol users, while 56 (50%) controls had a history of alcohol use (p = 0.17). Eighteen (37%) cases and 40 (36%) controls had a history of tobacco use (p = 0.93). One case and one control had a documented history of cocaine use (p = 0.52). Thirteen (34%) cases and 16 (21%) controls had a documented first-degree family history of hypertension (p = 0.18). One-third of the cases (16 patients) had a history of chronic kidney disease, while 10% (11 patients) of controls had a documented history of CKD; this difference was statistically significant (p = 0.0004).

HIV-associated Risk Factors

Twenty-six (54%) cases and 52 (49%) controls had a history of antiretroviral monotherapy (p = 0.56). Among both cases and controls, 92% (44 cases and 94 controls) had a documented history of exposure to protease inhibitors (p = 1.00). Exposure to lopinavir/ritonavir was significantly (p = 0.005) more likely in the control group (59 subjects; 58%) than in the case group (16 subjects; 33%). Fifty-eight per cent of cases (28 subjects) and 72% of controls (73 subjects) had a history of nonnucleoside reverse transcriptase inhibitor (NNRTI) exposure (p = 0.11). Twenty four (50%) cases and 47 (46%) controls had some history of ARV treatment interruption (p = 0.65). The median CD4 nadir of the case group was 177 [interquartile range (IQR): 86–454]; this was not statistically different from the median CD4 nadir in the control group (299, IQR: 79–515, p = 0.30).

Age, first-degree family history of hypertension, CKD, CD4 nadir ≤ 200 cells/μL, and lopinavir/ritonavir exposure were included in the stepwise logistic regression model. Chronic kidney disease, CD4 nadir, and lopinavir/ritonavir exposure were retained by the automated model. A history of CKD was associated with 4.32 [95% confidence interval (CI): 1.46–12.79] times the odds of being a case compared with a control. A CD4 nadir of ≤ 200 cells/μL was associated with 2.31 (95% CI: 0.92–5.81) times the odds of being a case compared with a control. Exposure to lopinavir/ritonavir was associated with significantly decreased odds of being a case compared with a control (adjusted odds = 0.20, 95% CI: 0.08–0.53).

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