Incident hypertension, cumulative viral load possibly linked in people with HIV
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Cumulative viral load may be associated with incident hypertension among people with HIV, despite CVD risk factors possibly differing between health care systems, researchers found.
Adovich S. Rivera, MD, PhD, postdoctoral research fellow at Kaiser Permanente Southern California, who was a PhD student at Northwestern University Feinberg School of Medicine at the time of the study, and colleagues analyzed 7,628 people with HIV without diabetes at baseline and 7,450 people with HIV without hypertension at baseline.
The data were collected from two Chicago health care systems: Northwestern Medicine, a large academic system that serves the greater Chicago area, and Howard Brown Health, a federally qualified center with a focus on LGBTQ+, low-income and uninsured populations.
Among the cohort, 71% were men, 47% were non-Hispanic white and the average age at first viral load measurement was 36 years. In the diabetes cohort, 3% had hypertension at baseline, whereas in the hypertension cohort, 7% had diabetes at baseline.
The Howard Brown Health cohort had lower unadjusted incidence rates than the Northwestern cohort for hypertension (2.6% vs. 16.9%) and diabetes (1.4% vs. 6.8%). During follow-up, in the cohort without baseline diabetes, 230 people developed diabetes (3%), and in the cohort without baseline hypertension, 496 developed hypertension (6.7%). The median time to event of the overall cohort was 3.1 years for hypertension and 3.2 years for diabetes, with longer time to event for those at Northwestern compared with those at Howard Brown Health (diabetes, 5.4 years vs. 2.7 years; hypertension, 5.3 years vs. 2.7 years).
In a pooled analysis, viremia copy-year was associated with incident hypertension (HR = 1.2; 95% CI, 1.14-1.26) but not incident diabetes (HR = 1.03; 95% CI, 0.96-1.1).
In addition, viremia copy-year was associated with incident hypertension in the Northwestern cohort (HR = 1.29; 95% CI, 1.08-1.32) but not the Howard Brown Health cohort (HR = 0.98; 95% CI, 0.86-1.02).
“Given prior observational and mechanistic data, we anticipated that higher viremia copy year (poor viral suppression over time) would be associated with higher risk for diabetes and hypertension. However, we only observed this higher hypertension risk with higher viremia copy-year in people with HIV being seen at an academic tertiary care setting but not in a community care setting,” Rivera and colleagues wrote.
Male sex, older age, Black race, Hispanic ethnicity, being part of the Northwestern subgroup and higher baseline BMI were associated with significantly higher hazards for both hypertension and diabetes. Having a higher baseline CD4 count was associated with higher hazards for hypertension but not diabetes. Private or uninsured/other insurance was associated with lower rates of hypertension and diabetes compared with public insurance.
Higher social deprivation index at both sites and diagnosis of mental health disorder at the Howard Brown Health site were associated with incident hypertension and diabetes, according to the researchers.
“Racial discrimination and having a mental health disorder could be sources of daily stress. Additionally, having a mental health disorder has been associated with social isolation and increased occurrence of traditional risk factors, both of which may increase hypertension risk. The combined result of different mechanisms, however, is hard to predict. We expected that LGBTQ+ would show higher risk because of minority stress and structural marginalizations. However, LGB individuals had significantly lower risk of diabetes compared to heterosexual people with HIV,” Rivera and colleagues wrote.
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