Hypertension is common among HIV-infected persons, but not associated with HAART.

BACKGROUND: With improved survival after the introduction of highly active antiretroviral therapy (HAART), non-AIDS-related morbidity and mortality have come to the forefront in the management of HIV patients. HAART has been linked to the development of several risk factors for cardiovascular disease including insulin resistance and hyperlipidemia, but its influence on hypertension requires further study. METHODS: We performed a cross-sectional study of HIV-infected persons at two large HIV clinics to evaluate the prevalence and factors associated with hypertension. Hypertension was defined by at least two blood pressure measurements >140/90 mmHg or the use of an antihypertensive medication. Statistical analyses included multivariate logistic regression models. RESULTS: We studied 707 HIV-infected adults with a median age of 41 years (IQR 36-46), 92% were male, 49% were Caucasian, and 72% were receiving HAART. The overall prevalence of hypertension was 31% and was similar among those receiving and not receiving HAART (32% vs. 29%, p = 0.47). Factors associated with hypertension in the multivariate model included increasing age, longer duration of HIV, higher body mass index, and diabetes, with a trend for African American ethnicity. CONCLUSIONS: Hypertension is common among HIV-infected persons and is associated with established risk factors, but not with HAART use. Given the high prevalence of hypertension and its association with duration of HIV infection, other factors such as virally-mediated endothelial changes or immune activation may play a role. Further investigations are needed.

Prevalence and factors associated with renal dysfunction among HIV-infected patients.

Renal dysfunction is an increasingly recognized non-AIDS-defining comorbidity among HIV-infected persons. The role of HIV-related factors in renal dysfunction remains unclear. We performed a cross-sectional study at two military clinics with open access to care to determine the impact of HIV factors, including antiretroviral therapy, on renal function. Renal dysfunction was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m(2). We evaluated 717 HIV patients with a median age of 41 years; 92% were male, 49% Caucasian, and 38% African American; median CD4 count was 515 cells/mm(3) and 73% were receiving highly active antiretroviral therapy (HAART). Twenty-two patients (3%) had renal dysfunction. Factors associated with renal dysfunction in the multivariate logistic analyses included older age (odds ratio [OR] 2.0 per 10 year increase, p = 0.006), lower CD4 nadir (OR 0.6 per 100 cell change, p = 0.02), and duration of tenofovir use (OR 1.5 per year use, p = 0.01). Among persons initiating tenofovir (n = 241), 50% experienced a reduction in GFR (median -10.5 mL/min/1.73 m(2), 95% CI, -8.9 to -13.3) within 2 years. Among tenofovir users, factors associated with a reduction in GFR included female gender (p < 0.001), African American ethnicity (p = 0.003), and lower CD4 nadir (p = 0.002). In summary, renal dysfunction was relatively uncommon among our HIV-infected patients, perhaps due to their young age, lack of comorbidities, or as a result of our definition that did not include proteinuria. Renal dysfunction was associated with duration of tenofovir use. Factors associated with renal loss among tenofovir users included female gender, African American ethnicity, and CD4 nadir <200 cells/mm(3). Consideration for more frequent monitoring of kidney function among these select HIV patients may be warranted.

Obesity among patients with HIV: the latest epidemic.

Since the advent of highly active antiretroviral therapy (HAART), studies have been conflicting regarding weight information among patients with HIV. We performed a retrospective study among male patients with HIV between June 2004 and June 2005 at two large U.S. Navy HIV clinics to describe the prevalence and factors associated with being overweight/obese. Rates of obesity/overweight among HIV-positive patients were also compared to data from HIV-negative military personnel. Of the 661 HIV-infected patients, 419 (63%) were overweight/obese and only 5 (1%) were underweight. Patients with HIV had a mean age of 41.0 years (range, 20-73 years) and were racially diverse. The prevalence rates of being overweight/obese at the last visit were similar among both HIV-positive and -negative military members. Being overweight/obese at the last clinic visit was associated with gaining weight during the course of HIV infection (10.4 versus 4.0 pounds, p < 0.001), hypertension (36% versus 23%, p = 0.001), low high-density lipoprotein (HDL; 40% versus 31%, p < 0.001), and a higher CD4 cell count at last visit (592 versus 499 cells/mm(3), p < 0.001). These data demonstrate that patients with HIV in the HAART era are commonly overweight and/or obese with rates similar to the general population. Being overweight/obese is associated with hypertension and dyslipidemia. Weight assessment and management programs should be a part of routine HIV clinical care.