People on HIV treatment are known to be more prone to certain health problems from these drugs, one of which is high blood pressure. These problems have been increasingly seen as antiretroviral treatments allow people with HIV to live much longer.
That is why a group of researchers analyzed the relationship between certain types of antiretroviral drugs, as well as other factors, and high blood pressure, a condition that can result in strokes, damage to the blood vessels of the eyes or the enlargement and overexertion of the heart, among other complications.
A major problem
In the general population, hypertension mainly affects older adults and those who are overweight or obese, those who use tobacco or alcohol heavily, and those with high levels of lipids (fats) in the body. But, according to the specialized portal of the Working Group on HIV Treatments (gTt-HIV), up to a third of people on antiretroviral treatment have high blood pressure.
A recent study published in the medical journal HIV Medicine revealed that this condition is more commonly found in those taking a specific type of antiretroviral drug called integrase inhibitors, and that it is, in fact, one of the newer types (compared to with those that emerged in the 1990s). A significant effect on blood pressure was also seen when using protease inhibitor-type treatments.
Other risk factors identified by the study were having been diagnosed with AIDS (the syndrome that appears when the defense system is severely damaged), a low CD4 defense cell count (less than 350 cells/mm3 of blood) and being elderly or obese.
A complex overview
In people with HIV, metabolic problems and persistent inflammation caused by the infection also play a role, but the researchers in this study chose to focus on the effect of some antiretroviral.
For their analysis, they took into account a large set of 17 study groups from Europe and Australia, comprising a total of more than 32,000 participants, who were followed up between 2012 and 2019. By ruling out those with high blood pressure before starting their antiretroviral treatment and who did not have their blood pressure records at the start date, 4,606 people were included in the study.
Sixty-eight percent of the participants were taking an integrase inhibitor, while 13% were taking a protease inhibitor and 17.5% were taking other medications called non-nucleotide reverse transcriptase inhibitors (NNRTIs).
During just 1.5 years of follow-up, 23% of all participants developed high blood pressure. However, in the group taking integrase inhibitors, the incidence of hypertension was 76% higher than the group taking NNRTIs.
On the other hand, when data from people taking integrase inhibitors and those taking protease inhibitors were compared, the scientists found no significant differences in the incidence of hypertension.
In addition, the researchers looked at other factors that increased the risk of high blood pressure, including a low CD4 count at the start of treatment, being older, having diabetes, having a body mass index greater than 30, having been diagnosed with AIDS and not having taken antiretroviral treatment before, but none of these factors were as relevant as the antiretroviral treatment itself.
It should be noted that the most commonly used integrase inhibitors were dolutegravir, elvitegravir, and raltegravir, while the most common protease inhibitor was darunavir.
These results are a reminder that the management of antiretroviral treatment must be carried out by specialists who know how to obtain the best benefits from all available drugs. If you have suspended or have not yet started your antiretroviral treatment, come to AHF Latin America and the Caribbean and we will help you connect with health institutions. Just come to our offices in your country and we can guide you there.
