Incidence of hypertension among persons living with HIV in China: a multicenter cohort study
Incidence of hypertension among persons living with HIV in China: a multicenter cohort study
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DOI：
10.1186/s12889-020-08586-9
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发表时间：
2020-06-01
影响因子：
4.5
通讯作者：
Li, Taisheng
中科院分区：
文献类型：
--
作者：
Fan, Hongwei;Guo, Fuping;Li, Taisheng
随着抗逆转录病毒治疗（ART）的普及，艾滋病毒感染者（PLWH）的预期寿命有所改善，但慢性合并症的发病率同时增加。没有关于中国PLWH中高血压发病率的数据。方法对两项在中国开展的PLWH启动ART的前瞻性纵向多中心研究的患者资料进行分析。计算PLWH中每100人年（PY）的高血压发病率，并使用考克斯比例风险模型来评估高血压与传统和HIV相关危险因素之间的关系。结果在纳入的1078例患者中，984例ART初治患者在基线时无高血压，随访2337.7 PY，中位随访时间为1.8年（范围：1.2-3.2），高血压发生率为7.6 [95%置信区间（CI）：6.5-8.7]/100 PY。在考克斯回归分析中，高血压的发病率与体重指数呈正相关[校正风险比（aHR）1.07（1.01，1.13），p = 0.02]和近期病毒载量（aHR 1.28，95%CI：1.08-1.51，p < 0.01），与近期CD 4 +/CD 8+比值呈负相关（aHR 0.14，95% CI：0.06-0.31，p < 0.001），齐多夫定暴露（aHR 0.15，95%CI：0.10-0.24，p < 0.001）和富马酸替诺福韦酯暴露（aHR 0.13，95%CI：0.08-0.21，p < 0.001）。结论中国艾滋病病毒携带者中接受抗逆转录病毒治疗的人群高血压发生率较高，近期CD 4 +/CD 8+比值降低和HIV病毒血症与高血压发生相关，而接受抗逆转录病毒治疗的人群高血压发生风险降低。高血压可以通过良好的艾滋病毒护理得到部分缓解，包括使用ART抑制病毒。
Background Life expectancy among persons living with HIV (PLWH) has improved with increasing access to antiretroviral therapy (ART), however incidence of chronic comorbidities has simultaneously increased. No data are available regarding the incidence of hypertension among Chinese PLWH. Methods We analyzed data collected from patients enrolled in two prospective longitudinal multicenter studies of PLWH initiating ART in China. Incidence rate of hypertension per 100 person-years (PYs) among PLWH was calculated, and Cox proportional hazards models was used to evaluate the association between incident hypertension and traditional and HIV-associated risk factors. Results Of 1078 patients included in this analysis, 984 ART-naive patients were hypertension-free at baseline, and contributed 2337.7 PYs of follow up, with a median follow-up period of 1.8 years (range: 1.2-3.2) after initiation of ART. Incidence of hypertension was 7.6 [95% confidence interval (CI): 6.5-8.7] per 100 PYs. In the Cox regression analysis, incidence of hypertension was positively associated with body mass index [adjusted hazard ratio (aHR) 1.07 (1.01,1.13), p = 0.02] and recent viral load (aHR 1.28, 95% CI:1.08-1.51, p < 0.01), and negatively associated with recent CD4+/CD8+ ratio (aHR 0.14, 95% CI:0.06-0.31, p < 0.001), zidovudine exposure (aHR 0.15, 95% CI: 0.10-0.24, p < 0.001) and tenofovir disoproxil fumarate exposure (aHR 0.13, 95% CI: 0.08-0.21, p < 0.001). Conclusions The incidence of hypertension was relatively high among Chinese PLWH initiating ART. Recent low CD4+/CD8+ ratio and detectable HIV viremia were associated with incident hypertension, whereas receipt of ART was associated with reduced risk. Hypertension may be mitigated, in part, by excellent HIV care, including viral suppression with ART.