Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy
BackgroundHypertension is common in people living with HIV (PLWH) on antiretroviral therapy (ART). In the general population and in experimental animal models, the incidence of hypertension is greater in males than in females, especially during the premenopausal period. However, it is not known whet...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1006789/full |
| _version_ | 1798017910361292800 |
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| author | Sepiso K. Masenga Sepiso K. Masenga Joreen P. Povia Katongo H. Mutengo Benson M. Hamooya Selestine Nzala Douglas C. Heimburger Douglas C. Heimburger Sody M. Munsaka Fernando Elijovich Kaushik P. Patel Annet Kirabo |
| author_facet | Sepiso K. Masenga Sepiso K. Masenga Joreen P. Povia Katongo H. Mutengo Benson M. Hamooya Selestine Nzala Douglas C. Heimburger Douglas C. Heimburger Sody M. Munsaka Fernando Elijovich Kaushik P. Patel Annet Kirabo |
| author_sort | Sepiso K. Masenga |
| collection | DOAJ |
| description | BackgroundHypertension is common in people living with HIV (PLWH) on antiretroviral therapy (ART). In the general population and in experimental animal models, the incidence of hypertension is greater in males than in females, especially during the premenopausal period. However, it is not known whether there are sex differences in hypertension associated with HIV and ART, and the factors contributing to incident hypertension among PLWH have not been well characterized. In this study, we aimed to determine the time course, sex differences and factors associated with incident hypertension in PLWH initiating ART.Methods and resultsWe conducted a retrospective study in which we used programmatic data from the ART registry to identify sex differences in the determinants of incident hypertension among PLWH initiating the ART regimen from Livingstone University Teaching Hospital in Zambia and followed for 8 years. Males developed hypertension earlier, 2 years after initiating ART, compared to 6 years in females. In multivariable analysis, increasing age, baseline systolic blood pressure and baseline mean arterial pressure (MAP) were associated with increased risk for developing incident hypertension. Also, participants who switched to the integrase strand transfer inhibitor, dolutegravir (DTG) or the protease inhibitor, lopinavir boosted with ritonavir were 2 and 3 times more likely to develop hypertension when compared to those on non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, these relationships were abrogated by sex, as self-reported male sex was the major contributor in predicting incident hypertension. While none of the factors remained significantly associated with incident hypertension upon multivariate analysis among females, body mass index (BMI), and use of protease inhibitors remained strongly associated with hypertension among males.ConclusionOur results indicate that the use of protease inhibitors and BMI are important predictors of incident hypertension among males. Thus, blood pressure and BMI should be closely monitored, particularly in males living with HIV on protease inhibitors. In addition, identifying specific factors that protect females from developing hypertension early is important but remains to be determined. |
| first_indexed | 2024-04-11T16:15:16Z |
| format | Article |
| id | doaj.art-3f3b1f4463554134832e68f1fc7d56f1 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T16:15:16Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-3f3b1f4463554134832e68f1fc7d56f12022-12-22T04:14:34ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.10067891006789Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapySepiso K. Masenga0Sepiso K. Masenga1Joreen P. Povia2Katongo H. Mutengo3Benson M. Hamooya4Selestine Nzala5Douglas C. Heimburger6Douglas C. Heimburger7Sody M. Munsaka8Fernando Elijovich9Kaushik P. Patel10Annet Kirabo11HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaSchool of Medicine, University of Zambia, Lusaka, ZambiaHAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaHAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaHAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaSchool of Medicine, University of Zambia, Lusaka, ZambiaSchool of Medicine, University of Zambia, Lusaka, ZambiaDepartment of Medicine, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United StatesDepartment of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, ZambiaDepartment of Medicine, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United StatesDepartment of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United StatesDepartment of Medicine, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United StatesBackgroundHypertension is common in people living with HIV (PLWH) on antiretroviral therapy (ART). In the general population and in experimental animal models, the incidence of hypertension is greater in males than in females, especially during the premenopausal period. However, it is not known whether there are sex differences in hypertension associated with HIV and ART, and the factors contributing to incident hypertension among PLWH have not been well characterized. In this study, we aimed to determine the time course, sex differences and factors associated with incident hypertension in PLWH initiating ART.Methods and resultsWe conducted a retrospective study in which we used programmatic data from the ART registry to identify sex differences in the determinants of incident hypertension among PLWH initiating the ART regimen from Livingstone University Teaching Hospital in Zambia and followed for 8 years. Males developed hypertension earlier, 2 years after initiating ART, compared to 6 years in females. In multivariable analysis, increasing age, baseline systolic blood pressure and baseline mean arterial pressure (MAP) were associated with increased risk for developing incident hypertension. Also, participants who switched to the integrase strand transfer inhibitor, dolutegravir (DTG) or the protease inhibitor, lopinavir boosted with ritonavir were 2 and 3 times more likely to develop hypertension when compared to those on non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, these relationships were abrogated by sex, as self-reported male sex was the major contributor in predicting incident hypertension. While none of the factors remained significantly associated with incident hypertension upon multivariate analysis among females, body mass index (BMI), and use of protease inhibitors remained strongly associated with hypertension among males.ConclusionOur results indicate that the use of protease inhibitors and BMI are important predictors of incident hypertension among males. Thus, blood pressure and BMI should be closely monitored, particularly in males living with HIV on protease inhibitors. In addition, identifying specific factors that protect females from developing hypertension early is important but remains to be determined.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1006789/fullincident hypertensionHIVdolutegravirprotease inhibitorsblood pressurelopinavir |
| spellingShingle | Sepiso K. Masenga Sepiso K. Masenga Joreen P. Povia Katongo H. Mutengo Benson M. Hamooya Selestine Nzala Douglas C. Heimburger Douglas C. Heimburger Sody M. Munsaka Fernando Elijovich Kaushik P. Patel Annet Kirabo Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy Frontiers in Cardiovascular Medicine incident hypertension HIV dolutegravir protease inhibitors blood pressure lopinavir |
| title | Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy |
| title_full | Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy |
| title_fullStr | Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy |
| title_full_unstemmed | Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy |
| title_short | Sex differences in hypertension among people living with HIV after initiation of antiretroviral therapy |
| title_sort | sex differences in hypertension among people living with hiv after initiation of antiretroviral therapy |
| topic | incident hypertension HIV dolutegravir protease inhibitors blood pressure lopinavir |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1006789/full |
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