Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study.
Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study.
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DOI：
10.1111/hiv.12639
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发表时间：
2018-10
期刊：
影响因子：
3
通讯作者：
Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group
中科院分区：
文献类型：
--
作者：
Hatleberg CI;Ryom L;d'Arminio Monforte A;Fontas E;Reiss P;Kirk O;El-Sadr W;Phillips A;de Wit S;Dabis F;Weber R;Law M;Lundgren JD;Sabin C;Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group
本文提出的研究结果表明，在hiv阳性个体中，抗逆转录病毒药物的累积暴露与临床相关的高血压风险增加无关。高血压风险增加主要与传统的心血管疾病风险因素有关。先前的研究表明，hiv阳性个体的高血压主要与年龄、糖尿病和血脂异常等传统风险因素有关。然而，关于抗逆转录病毒（ARV）药物暴露是否会带来额外风险的争议仍然存在，我们在D:A:D队列中调查了这个问题。高血压的发病率（收缩压(BP) >140和/或舒张压> 90mmhg和/或开始抗高血压治疗）是由人口统计学、代谢和hiv相关因素确定的，包括每种ARV药物的累积暴露。使用单变量和多变量泊松回归模型确定高血压的预测因子。在33,278例纳入研究的患者中，7636例（22.9%）在223,149例患者年（发病率：3.42 [95% CI 3.35-3.50]/100 PYRS）中出现高血压。在单变量分析中，大多数抗逆转录病毒药物的累积暴露与高血压风险增加有关。在调整了人口统计学、代谢和hiv相关因素后，只有奈韦拉平（比率比1.07 [95% CI 1.04-1.13]/5年）和因地那韦/利托那韦（比率比1.12 [95% CI 1.04-1.13]/5年）的相关性仍然具有统计学意义，尽管影响很小。高血压最强的独立预测因子是男性、年龄较大、非洲黑人、糖尿病、血脂异常、使用降脂药物、高BMI、肾功能损害和低CD4计数。我们没有发现任何证据表明暴露于任何一种抗逆转录病毒药物与高血压风险之间存在任何强有力的独立关联。研究结果为艾滋病毒阳性人群的高血压筛查政策和预防措施应遵循适用于一般人群的算法提供了保证。
This article presents findings indicating that cumulative exposure to antiretroviral drugs is not associated with a clinically relevant increased risk of hypertension in HIV-positive individuals. Increased risk of hypertension is mainly linked to traditional cardiovascular disease risk factors. Previous studies have suggested that hypertension in HIV-positive individuals is associated primarily with traditional risk factors such as older age, diabetes and dyslipidemia. However, controversy remains as to whether exposure to antiretroviral (ARV) drugs poses additional risk, and we investigated this question in the D:A:D cohort. The incidence of hypertension (systolic blood pressure (BP) >140 and/or diastolic BP >90 mmHg and/or initiation of antihypertensive treatment) was determined overall and in strata defined by demographic, metabolic- and HIV-related factors, including cumulative exposure to each individual ARV drug. Predictors of hypertension were identified using uni- and multivariable Poisson regression models. Of 33,278 included persons, 7636 (22.9%) developed hypertension over 223,149 person years (Incidence rate: 3.42 [95% CI 3.35–3.50]/100 PYRS). In univariable analyses, cumulative exposure to most ARV drugs was associated with an increased risk of hypertension. After adjustment for demographic, metabolic and HIV-related factors, only associations for nevirapine (rate ratio 1.07 [95% CI 1.04–1.13]/5 years) and indinavir/ritonavir (1.12 [1.04–1.20]/5 years) remained statistically significant, although effects were small. The strongest independent predictors of hypertension were male gender, older age, black African ethnicity, diabetes, dyslipidemia, use of lipid-lowering drugs, high BMI, renal impairment and a low CD4 count. We did not find evidence for any strong independent association between exposure to any of the individual ARV drugs and the risk of hypertension. Findings provide reassurance that screening policies and preventative measures for hypertension in HIV-positive persons should follow algorithms used for the general population.
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