Samson Okello1, Stephen B Asiimwe, Michael Kanyesigye, Winnie R Muyindike, Yap Boum, Bosco B Mwebesa, Jessica E Haberer, Yong Huang, Kenneth Williams, Tricia H Burdo, Russell P Tracy, David R Bangsberg, A Rain Mocello, Jeffrey N Martin, Peter W Hunt, Mark J Siedner. 1. *Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; †Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA; ‡Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; §Epicentre Mbarara Research Centre, Mbarara, Uganda; ‖Center for Global Health, Massachusetts General Hospital, Boston, MA; ¶Harvard Medical School, Massachusetts General Hospital, Boston, MA; #Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA; **Department of Biology, Boston College, Chestnut Hill, MA; ††Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT; ‡‡Department of Global Health and Populations, Harvard T.H Chan School of Public Health, Boston, MA; and §§Department of Medicine, University of California, San Francisco, CA.
Abstract
OBJECTIVES: We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda. METHODS: We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. RESULTS: In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio. CONCLUSION: BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.
OBJECTIVES: We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda. METHODS: We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. RESULTS: In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio. CONCLUSION: BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.
Authors: Peter W Hunt; Huyen L Cao; Conrad Muzoora; Isaac Ssewanyana; John Bennett; Nneka Emenyonu; Annet Kembabazi; Torsten B Neilands; David R Bangsberg; Steven G Deeks; Jeffrey N Martin Journal: AIDS Date: 2011-11-13 Impact factor: 4.177
Authors: Katherine Krauskopf; Mark L Van Natta; Ronald P Danis; Sapna Gangaputra; Lori Ackatz; Adrienne Addessi; Alex D Federman; Andrea D Branch; Curtis L Meinert; Douglas A Jabs Journal: J Int Assoc Provid AIDS Care Date: 2013 Sep-Oct
Authors: Ingjerd W Manner; Marius Trøseid; Olav Oektedalen; Morten Baekken; Ingrid Os Journal: J Clin Hypertens (Greenwich) Date: 2012-10-26 Impact factor: 3.738
Authors: Petronela Ancuta; Anupa Kamat; Kevin J Kunstman; Eun-Young Kim; Patrick Autissier; Alysse Wurcel; Tauheed Zaman; David Stone; Megan Mefford; Susan Morgello; Elyse J Singer; Steven M Wolinsky; Dana Gabuzda Journal: PLoS One Date: 2008-06-25 Impact factor: 3.240
Authors: Michael J A Reid; Yifei Ma; Iya Golovaty; Samson Okello; Ruth Sentongo; Maggie Feng; Alexander C Tsai; Bernard Kakuhikire; Russell Tracy; Peter W Hunt; Mark Siedner; Phyllis C Tien Journal: AIDS Patient Care STDS Date: 2019-06-12 Impact factor: 5.078
Authors: Ashita S Batavia; Patrice Severe; Myung Hee Lee; Alexandra Apollon; Yuan Shan Zhu; Kathryn M Dupnik; Margaret L McNairy; Jean W Pape; Daniel W Fitzgerald; Robert N Peck Journal: J Hypertens Date: 2018-07 Impact factor: 4.844
Authors: Samson Okello; June-Ho Kim; Ruth N Sentongo; Russell Tracy; Alexander C Tsai; Bernard Kakuhikire; Mark J Siedner Journal: J Clin Hypertens (Greenwich) Date: 2019-07-06 Impact factor: 3.738
Authors: Sepiso K Masenga; Benson M Hamooya; Selestine Nzala; Geoffrey Kwenda; Douglas C Heimburger; Wilbroad Mutale; Sody M Munsaka; John R Koethe; Annet Kirabo Journal: Curr Hypertens Rep Date: 2019-06-04 Impact factor: 5.369
Authors: Jennifer Manne-Goehler; Mark J Siedner; Livia Montana; Guy Harling; Pascal Geldsetzer; Julia Rohr; F Xavier Gómez-Olivé; Alexander Goehler; Alisha Wade; Thomas Gaziano; Kathleen Kahn; Justine I Davies; Stephen Tollman; Till W Bärnighausen Journal: J Int AIDS Soc Date: 2019-03 Impact factor: 5.396
Authors: Mark J Siedner; Prossy Bibangambah; June-Ho Kim; Alexander Lankowski; Jonathan L Chang; Isabelle T Yang; Douglas S Kwon; Crystal M North; Virginia A Triant; Christopher Longenecker; Brian Ghoshhajra; Robert N Peck; Ruth N Sentongo; Rebecca Gilbert; Bernard Kakuhikire; Yap Boum; Jessica E Haberer; Jeffrey N Martin; Russell Tracy; Peter W Hunt; David R Bangsberg; Alexander C Tsai; Linda C Hemphill; Samson Okello Journal: J Am Heart Assoc Date: 2021-06-05 Impact factor: 6.106