Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Medicine
Byonanebye et al. on behalf of the RESPOND consortium aimed to compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitors (INSTI-) based regimens versus those receiving contemporary non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs), within a large consortium of HIV cohorts.
Hypertension was defined as two consecutive systolic blood pressure (BP) measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives.
Overall, 4’606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113– 130) mmHg, 78 (70– 82) mmHg, and 43 (34– 50) years, respectively. Over 8’380.4 person- years (median follow- up 1.5 [IQR 1.0– 2.7] years), 1’058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person- years, 95% confidence interval [CI] 118.9– 134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receiving NNRTIs (aIRR 1.76; 95% CI 1.47– 2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89– 1.29). The results were similar when the analysis was stratified by ART status at baseline.
In conclusion, the results of this analysis show a high incidence of hypertension in people living with HIV and suggest that contemporary ART regimens are differentially associated with hypertension. Hypertension was more common with INSTIs than with NNRTIs, but the incidence was not different with PIs, although we cannot entirely exclude potential channelling bias and residual confounding. Whether the higher risk of hypertension with INSTIs is associated with weight gain will be explored in a planned analysis within RESPOND. The results suggest that participants with prior AIDS or traditional risk factors should be monitored for hypertension at each visit, especially after initiating INSTIs and PIs. Future studies should investigate the risk of hypertension due to individual INSTIs and the relationship between INSTI-associated weight gain and hypertension.