HIV infection and hypertension: Epidemiological and pathogenetic aspects
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AbstractAfter introduction of antiretroviral therapy (ART), an increased risk of cardiovascular disease (CVD) and other non-AIDS related diseases has been observed HIV-infected individuals. Hypertension is a major risk factor for CVD. Chronic immune dysfunction has been proposed as a driving force of CVD in HIV-infection, and microbial translocation, i.e. the translocation of bacterial products from the gut into the systemic circulation, is a contributor to chronic immune dysfunction in HIV. The overall aims of the thesis were to describe hypertension in HIV-infected patients, and to explore putative HIV-specific risk factors for hypertension.
In a longitudinal study, blood pressure levels were followed in 434 HIV-infected individuals over a period of 3.5 years. Nadir CD4 cell count was recorded as the lowest CD4 cell count ever for each individual. Around 10% of the persons developed new-onset hypertension, and increased HIV duration was an independent predictor of new-onset hypertension. Close to one third (28%) of the study population were hypertensive throughout the study period. Advanced immunodeficiency, i.e. nadir CD4 < 50 cells/µL, as well as the duration of ART were independent predictors of sustained hypertension in addition to classical risk factors. In an exploratory study which included 42 HIV-infected individuals, microbial translocation was quantified by levels of lipopolysaccharide (LPS). LPS was measured in blood samples collected at the time of nadir CD4 count, and all participants were ART-naïve at nadir. LPS was inversely correlated with nadir CD4 cell count. LPS adjusted for age and gender was a predictor of later blood pressure level and hypertension.
In conclusion, HIV-related factors such as advanced immunodeficiency, duration of ART and microbial translocation may contribute to the development of hypertension in HIV-infected individuals. Microbial translocation may in fact explain the association between previous immunodeficiency and hypertension.
List of papers. The papers are removed from the thesis due to publisher restrictions.
Paper I: Hypertension and antihypertensive treatment in HIV-infected individuals. A Longitudinal cohort study. Ingjerd W. Manner, Morten Baekken, Olav Oektedalen, Ingrid Os. Blood Pressure, 2012;21:311-19. doi:10.3109/08037051.2012.680742
Paper II: Low Nadir CD4 Cell Count Predicts Sustained Hypertension in HIV-Infected Individuals. Ingjerd W. Manner, Marius Trøseid, Olav Oektedalen, Morten Baekken, Ingrid Os. The Journal of Clinical Hypertension, 2013;15:101-106. doi:10.1111/jch.12029
Paper III: Markers of microbial translocation predict hypertension in HIVinfected individuals. Ingjerd W. Manner, Morten Baekken, Dag Kvale, Olav Oektedalen, Maria Pedersen, Susanne Dam Nielsen, Piotr Nowak, Ingrid Os, Marius Trøseid. HIV Medicine, 2013;14:354-361. doi:10.1111/hiv.12015