Division of Infectious Diseases, Mount Sinai School of Medicine, New York, NY 10029, USA.
HIV Med. 2013 Jul;14(6):337-46. doi: 10.1111/hiv.12010. Epub 2013 Jan 7.
Antiretroviral (ARV) therapy has prolonged the life expectancy of HIV-infected persons, increasing their risk of age-associated diseases, including atherosclerosis (AS). Decreased risk of AS has been associated with the prevention and control of hypertension (HTN). We conducted a cohort study of perimenopausal women and older men with or at risk of HIV infection to identify risk factors for incident HTN.
Standardized interviews, physical examinations, and laboratory examinations were scheduled at 6-month intervals. Interview data included demographics, medical, family, sexual behaviour and drug use histories, and physical activity.
There were 330 women and 329 men eligible for inclusion in the study; 27% and 35% of participants developed HTN during a median follow-up period of 1080 and 1071 days, respectively. In gender-stratified analysis, adjusting for traditional HTN risk factors (age, race, body mass index, smoking, diabetes, family history of HTN, alcohol dependence, physical activity and high cholesterol), HIV infection was not associated with incident HTN in women [hazard ratio (HR) 1.31; 95% confidence interval (CI) 0.56, 3.06] or men (HR 1.67; 95% CI 0.75, 3.74). Among HIV-infected women, although exposure to ARVs was not significantly associated with incident HTN (HR 0.72; 95% CI 0.26, 1.99), CD4 T-cell count was positively associated with incident HTN (HR 1.15 per 100 cells/μL; 95% CI 1.03, 1.28). Among physically active HIV-infected men, exposure to ARVs was negatively associated with incident HTN (HR 0.15; 95% CI 0.03, 0.78).
HIV infection was not associated with incident HTN in older men or women. This study provides additional evidence supporting a causal relationship between immune function and incident HTN, which warrants further study.
抗逆转录病毒（ARV）治疗延长了 HIV 感染者的预期寿命，增加了他们患与年龄相关疾病的风险，包括动脉粥样硬化（AS）。AS 风险降低与高血压（HTN）的预防和控制有关。我们对围绝经期妇女和有或有感染 HIV 风险的老年男性进行了队列研究，以确定发生 HTN 的危险因素。
每隔 6 个月安排标准化访谈、体检和实验室检查。访谈数据包括人口统计学、医疗、家庭、性行为和药物使用史以及体育活动。
共有 330 名女性和 329 名男性符合纳入研究条件；在中位随访 1080 天和 1071 天期间，分别有 27%和 35%的参与者发生了 HTN。在性别分层分析中，调整了传统 HTN 危险因素（年龄、种族、体重指数、吸烟、糖尿病、HTN 家族史、酒精依赖、体育活动和高胆固醇）后，HIV 感染与女性发生 HTN 无关（危险比[HR] 1.31；95%置信区间[CI] 0.56，3.06）或男性（HR 1.67；95% CI 0.75，3.74）。在 HIV 感染的女性中，尽管接触 ARV 与发生 HTN 无显著相关性（HR 0.72；95% CI 0.26，1.99），但 CD4 T 细胞计数与发生 HTN 呈正相关（每增加 100 个细胞/μL，HR 为 1.15；95% CI 1.03，1.28）。在活跃的 HIV 感染男性中，接触 ARV 与发生 HTN 呈负相关（HR 0.15；95% CI 0.03，0.78）。
HIV 感染与老年男性或女性发生 HTN 无关。本研究提供了额外的证据支持免疫功能与发生 HTN 之间存在因果关系，值得进一步研究。
