Okeke Nwora Lance, Davy Thibaut, Eron Joseph J, Napravnik Sonia
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, Duke University, Durham.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill.
Clin Infect Dis. 2016 Jul 15;63(2):242-8. doi: 10.1093/cid/ciw223. Epub 2016 Apr 18.
Persons infected with human immunodeficiency virus (HIV) are at higher risk for major cardiovascular disease (CVD) events than uninfected persons. Understanding the epidemiology of major traditional CVD risk determinants, particularly hypertension, in this population is needed.
The study population included HIV-infected patients participating in the UNC CFAR HIV Clinical Cohort from 1996 to 2013. Annual incidence rates of hypertension were calculated. Multivariable Poisson models were fit to identify factors associated with incident hypertension.
3141 patients contributed 21 956 person-years (PY) of follow-up. Overall, 57% patients were black, 28% were women, and the median age was 35 years. Hypertension age-standardized incidence rates increased from 1.68 cases per 100 PYs in 1996 to 5.35 cases per 100 PYs in 2013 (P < .001). In adjusted analyses, hypertension rates were higher among obese patients (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI], 1.43-2.02), and those with diabetes mellitus (IRR 1.44, 95% CI, 1.14-1.83) and renal insufficiency (IRR 1.36, 95% CI, 1.16-1.61), but lower among patients with a CD4 nadir of ≥500 cells/mm(3) (IRR 0.73, 95% CI, .53-1.01).
The incidence of hypertension increased from 1996 to 2013, alongside increases in traditional hypertension risk determinants. Notably, HIV-related immunosuppression and ongoing viral replication may contribute to an increased hypertension risk. Aggressive CVD risk factor management, early HIV diagnosis, linkage to care, antiretroviral therapy initiation, and durable viral suppression, will be important components of a comprehensive primary CVD prevention strategy in HIV-infected persons.
感染人类免疫缺陷病毒（HIV）的人群发生主要心血管疾病（CVD）事件的风险高于未感染者。需要了解该人群中主要传统CVD风险决定因素的流行病学情况，尤其是高血压。
研究人群包括1996年至2013年参与北卡罗来纳大学艾滋病研究中心HIV临床队列研究的HIV感染患者。计算高血压的年发病率。采用多变量泊松模型来确定与新发高血压相关的因素。
3141名患者提供了21956人年（PY）的随访数据。总体而言，57%的患者为黑人，28%为女性，中位年龄为35岁。高血压年龄标准化发病率从1996年的每100人年1.68例增加到2013年的每100人年5.35例（P < 0.001）。在多因素分析中，肥胖患者（发病率比[IRR] 1.70，95%置信区间[CI]，1.43 - 2.02）、糖尿病患者（IRR 1.44，95% CI，1.14 - 1.83）和肾功能不全患者（IRR 1.36，95% CI，1.16 - 1.61）的高血压发病率较高，但CD4最低点≥500个细胞/mm³的患者发病率较低（IRR 0.73，95% CI，0.53 - 1.01）。
从1996年到2013年，高血压发病率上升，同时传统高血压风险决定因素也有所增加。值得注意的是，HIV相关的免疫抑制和持续的病毒复制可能导致高血压风险增加。积极管理CVD危险因素、早期HIV诊断、与医疗服务机构建立联系、启动抗逆转录病毒治疗以及实现持久的病毒抑制，将是HIV感染者全面初级CVD预防策略的重要组成部分。
