Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. HIV Medicine
Hatleberg et al. on behalf of the D:A:D study group aimed to re-investigate the potential associations between exposure to individual antiretroviral (ARV) drugs and the risk of hypertension, as well as to identify non-ARV predictors of hypertension.
Hypertension was defined to have two consecutive systolic blood pressure (SBP) measurements >140 mmHg and/or diastolic blood pressure (DBP) measurements > 90 mmHg. Of 33 278 included persons, 7636 (22.9%) developed hypertension over 223 149 person-years (PY) [incidence rate: 3.42 (95% confidence interval (CI) 3.35–3.50) per 100 PY]. In univariable analyses, cumulative exposure to most ARV drugs except darunavir/ritonavir was associated with an increased risk of hypertension. After adjustment for demographic, metabolic and HIV-related factors, only associations for nevirapine [rate ratio 1.07 (95% CI: 1.04–1.13) per 5 years] and indinavir/ritonavir [rate ratio 1.12 (95% CI: 1.04–1.20) per 5 years] remained statistically significant, although effects were small. The strongest independent predictors of hypertension were male gender, older age, black African. There was no association between current smoking and the risk of hypertension. CD4 count < 100 cells/lL was the strongest HIV-related predictor of hypertension.
In conclusion, the study did not find evidence for any significant clinically relevant independent associations between exposure to any of the investigated ARV drugs and hypertension risk, but did confirm the importance of traditional risk factors. These findings provide reassurance that, in addition to preventing immunosuppression in HIV-positive individuals by prompt initiation of antiretroviral therapy, screening policies and preventive measures for hypertension in HIV-positive persons should follow the algorithms used for the general population. However, continued pharmaco-vigilance is warranted for newer ARV drugs not investigated in this study.