1269. Immune activation and risk of Hypertension in HIV-Infected Adults initiating antiretroviral therapy in Uganda: A nested case-control study
Session: Oral Abstract Session: HIV Complications and Co-Infections
Friday, October 9, 2015: 2:36 PM
Room: 25--ABC

Background: Immune activation and inflammation are associated with risk of atherosclerosis among people living with HIV. It is not clear whether these factors also correlate with risk of hypertension.

Methods: We conducted a nested case-control study within a cohort in southwestern Uganda to detect associations between pre-ART immune activation and incident hypertension. Blood testing for CD4 count and plasma biomarkers (lipopolysaccharide, soluble CD14, soluble CD163, lnterleukin-6, kynurenine/tryptophan [K/T] ratio, and D-dimer were conducted at ART initiation and 6 months after. Participants had blood pressure measurements at each clinic visit. We defined a case as presence of systolic blood pressure ³ 140 and/or diastolic blood pressure ³ 90 mmHg on at least 3 consecutive visits after ART initiation. Controls were participants with a minimum of 3 visits and no elevated blood pressure readings after ART initiation. We used logistic regression to identify correlates of incident hypertension, with each interquartile range (IQR) increase in biomarker concentrations at ART initiation and 6 months after ART.  Models were adjusted for traditional cardiovascular risk factors and pre-ART CD4 counts.

Results: We identified 89 cases and 167 controls with a median follow up of 2.3 years after ART initiation; median age was 34 years. Male gender (AOR 2.36, 95% CI 1.03 - 1.11, p=0.008), increasing age (AOR 1.07, 95% CI 1.25 - 4.47, p< 0.001), obesity (AOR 9.80, 95% CI 1.87 - 51.3, p=0.007), and nadir CD4 cell count (< 250 cells) (AOR 1.51, 95% CI 0.27 - 0.98, p=0.042) were associated with incident hypertension.  Each IQR increase in D-dimer levels at ART initiation (AOR 0.82, 95% CI  0.45 - 1.48, p=0.057) and at 6 months (AOR 0.69, 95% CI  0.35 - 1.34, p=0.023) was associated with decreased risk of incident hypertension. Although not statistically significant, similar associations were seen for sCD14 and K/T ratio.

Conclusion: Among HIV-infected patients receiving ART in Uganda, increases in D-dimer, K/T ratio, and sCD14 were inversely correlated with incident hypertension. These results are in keeping with prior studies suggesting that hypertension risk among people with HIV is associated with traditional risk factors, and less so with HIV-associated inflammation.

Samson Okello, MBchB, MMED1,2, Stephen Asiimwe, MBchB, MMED, MSc2,3, Michael Kanyesigye, BSc4, Winnie R. Muyindike, MBchB, MMED2, Yap Boum II, PhD5, Jessica Haberer, MD6, David Bangsberg, MD, MPH6,7, A Rain Mocello, PhD3, Jeffery N. Martin, MD, MPH8, Peter Hunt, MD9 and Mark Siedner, MD MPH6, (1)Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, (2)Internal Medicine, Mbarara University of Science & Technology, Mbarara, Uganda, (3)Epidemiology & Biostatistics, University of California, San Fransico, CA, (4)Immune Suppression Syndrome Clinic, Mbarara University of Science & Technology, Mbarara, Uganda, (5)Laboratory Science, Mbarara University of Science & Technology, Mbarara, Uganda, (6)Center for Global Health, Massachusetts General Hospital, Boston, MA, (7)Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, (8)Epidemiology & Biostatistics, University of California, San Francisco, CA, (9)Medicine, University Of California, San Francisco, CA


S. Okello, None

S. Asiimwe, None

M. Kanyesigye, None

W. R. Muyindike, None

Y. Boum II, None

J. Haberer, None

D. Bangsberg, None

A. R. Mocello, None

J. N. Martin, None

P. Hunt, None

M. Siedner, None

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