Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study.
Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study.
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DOI：
10.1186/s12916-014-0125-2
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发表时间：
2014-07-29
期刊：
影响因子：
9.3
通讯作者：
Kataraihya JB
中科院分区：
文献类型：
--
作者：
Peck RN;Shedafa R;Kalluvya S;Downs JA;Todd J;Suthanthiran M;Fitzgerald DW;Kataraihya JB
艾滋病毒和高血压流行病正在撒哈拉以南非洲汇合。由于抗逆转录病毒疗法（ART），更多的艾滋病毒感染成年人寿命更长，体重增加，使他们面临更大的高血压和肾脏疾病风险。然而，在非洲成年人中，高血压、肾脏疾病和长期抗逆转录病毒治疗之间的关系仍然不清楚。因此，我们确定了高血压和肾脏疾病在HIV感染成人（ART初治和ART >2年）与HIV阴性成人的患病率。我们假设，即使在调整了年龄和肥胖因素后，接受抗逆转录病毒治疗的HIV感染成年人的高血压患病率也会更高。在2012年10月至2013年4月期间进行的这项横断面研究中，在坦桑尼亚参加HIV诊所的连续成年人（>18岁）被纳入三组：1）HIV阴性对照，2）HIV感染者，ART初治者，和3）接受ART治疗2年以上的HIV感染者。主要研究结果为高血压和肾脏疾病（均由国际指南定义）。我们通过Fisher精确检验比较了每个HIV感染组与对照组之间的高血压患病率。Logistic回归分析用于确定高血压患病率的差异是否完全由混杂因素解释。在艾滋病毒阴性成人中，25/153（16.3%）患有高血压（与最近的社区调查数据相似）。接受抗逆转录病毒治疗的艾滋病毒感染成年人高血压患病率较高（43/150（28.7%），P = 0.01），即使在调整后高血压的几率也较高（最佳模型中的比值比（OR）= 2.19（1.18至4.05），P = 0.01）。HIV感染、ART初治成人高血压患病率较低（8/151（5.3%），P = 0.003），调整后高血压的几率较低（OR = 0.35（0.15至0.84），最佳模型中P = 0.02）。在所有三组中，高血压成年人的高血压知晓率≤25%。肾脏疾病在这三个组中都很常见（25.6%至41.3%），与高血压密切相关（趋势P <0.001）;在高血压参与者中，50/76微量白蛋白尿占65.8%，（26.3%）的参与者估计肾小球滤过率（eGFR）<60，而血压正常的参与者为33/184（17.9%）和16/184（8.7%）。接受抗逆转录病毒治疗2年以上的艾滋病毒感染成人患高血压的几率是艾滋病毒阴性对照的两倍。患有高血压的艾滋病毒感染成年人很少知道他们的诊断，但通常有肾脏疾病的证据。撒哈拉以南非洲的艾滋病毒诊所需要进行密集的高血压筛查和教育。进一步的研究应该确定慢性失调性炎症是否会加速这一人群的高血压。
The epidemics of HIV and hypertension are converging in sub-Saharan Africa. Due to antiretroviral therapy (ART), more HIV-infected adults are living longer and gaining weight, putting them at greater risk for hypertension and kidney disease. The relationship between hypertension, kidney disease and long-term ART among African adults, though, remains poorly defined. Therefore, we determined the prevalences of hypertension and kidney disease in HIV-infected adults (ART-naive and on ART >2 years) compared to HIV-negative adults. We hypothesized that there would be a higher hypertension prevalence among HIV-infected adults on ART, even after adjusting for age and adiposity. In this cross-sectional study conducted between October 2012 and April 2013, consecutive adults (>18 years old) attending an HIV clinic in Tanzania were enrolled in three groups: 1) HIV-negative controls, 2) HIV-infected, ART-naive, and 3) HIV-infected on ART for >2 years. The main study outcomes were hypertension and kidney disease (both defined by international guidelines). We compared hypertension prevalence between each HIV group versus the control group by Fisher’s exact test. Logistic regression was used to determine if differences in hypertension prevalence were fully explained by confounding. Among HIV-negative adults, 25/153 (16.3%) had hypertension (similar to recent community survey data). HIV-infected adults on ART had a higher prevalence of hypertension (43/150 (28.7%), P = 0.01) and a higher odds of hypertension even after adjustment (odds ratio (OR) = 2.19 (1.18 to 4.05), P = 0.01 in the best model). HIV-infected, ART-naive adults had a lower prevalence of hypertension (8/151 (5.3%), P = 0.003) and a lower odds of hypertension after adjustment (OR = 0.35 (0.15 to 0.84), P = 0.02 in the best model). Awareness of hypertension was ≤25% among hypertensive adults in all three groups. Kidney disease was common in all three groups (25.6% to 41.3%) and strongly associated with hypertension (P <0.001 for trend); among hypertensive participants, 50/76 (65.8%) had microalbuminuria and 20/76 (26.3%) had an estimated glomerular filtration rate (eGFR) <60 versus 33/184 (17.9%) and 16/184 (8.7%) participants with normal blood pressure. HIV-infected adults on ART >2 years had two-fold greater odds of hypertension than HIV-negative controls. HIV-infected adults with hypertension were rarely aware of their diagnosis but often have evidence of kidney disease. Intensive hypertension screening and education are needed in HIV-clinics in sub-Saharan Africa. Further studies should determine if chronic, dysregulated inflammation may accelerate hypertension in this population.
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African Partnership for Chronic Disease Research (APCDR)
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