Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
BMC Public Health. 2020 Jun 1;20(1):834. doi: 10.1186/s12889-020-08586-9.
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.
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.
Of 1078 patients included in this analysis, 984 ART-naïve 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).
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.
ClinicalTrials.gov Identifier: NCT00872417 registered on 31 March, 2009, and NCT01844297 registered on 1 May, 2013.
随着抗逆转录病毒疗法（ART）的普及，艾滋病毒感染者（PLWH）的预期寿命得到了提高，但慢性合并症的发病率也同时增加。目前尚无中国 PLWH 中高血压发病率的数据。
我们分析了在中国进行的两项前瞻性纵向多中心 PLWH 开始接受 ART 的研究中收集的患者数据。计算 PLWH 每 100 人年（PY）的高血压发病率，并使用 Cox 比例风险模型评估高血压与传统和 HIV 相关危险因素之间的关联。
在本分析中，1078 例患者中有 984 例在基线时无高血压，在 ART 开始后贡献了 2337.7 PY 的随访，中位随访时间为 1.8 年（范围：1.2-3.2）。高血压的发病率为 7.6 [95%置信区间（CI）：6.5-8.7]每 100 PY。在 Cox 回归分析中，高血压的发病率与体重指数呈正相关[校正后的危险比（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 CD4+/CD8+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]和替诺福韦二吡呋酯暴露[aHR 0.13，95%CI：0.08-0.21，p<0.001）。
中国开始接受 ART 的 PLWH 中高血压的发病率相对较高。近期低 CD4+/CD8+比值和可检测到的 HIV 病毒载量与高血压的发生有关，而接受 ART 与降低风险有关。通过包括使用 ART 抑制病毒在内的良好的 HIV 护理，高血压可能在一定程度上得到缓解。
ClinicalTrials.gov 标识符：NCT00872417 于 2009 年 3 月 31 日注册，NCT01844297 于 2013 年 5 月 1 日注册。
