The Association of Antiretroviral Therapy and Hypertension among HIV-positive Individuals in Canada and Tanzania
Bibliographic record
Abstract
<strong>Introduction: </strong>Hypertension is an important worldwide public health concern and is a concomitant risk factor for brain, kidney and cardiovascular disease, such as myocardial infarction (MI). Highly Active Antiretroviral Therapy (HAART) has greatly increased life expectancy of HIV-positive persons, but has been associated with adverse effects. <strong>Objectives: </strong>To assess the association between antiretroviral therapy and incident hypertension; to estimate the incidence of hypertension; and to explore known and potential risk factors for hypertension among HIV-positive individuals in Tanzania and Canada. <strong>Methods: </strong>Subjects, 18 years and older, were enrolled into two retrospective cohort studies in Tanzania and Canada. Population and descriptive characteristics were summarized. Hypertension was defined as having a SBP>140 mmHg, DBP>90 mmHg, a diagnosis of high blood pressure, or receiving antihypertensive therapy. Statistical analyses, including independent t-tests, Chi-square tests, multiple linear regression, multivariable logistic and Cox regression were performed to assess for statistical significance (p<0.05) in SPSS14.0. <strong>Results: </strong>In Tanzania, 52 HIV-positive, normotensive subjects initiating antiretroviral therapy were enrolled. Subjects had a mean age (SD) of 39.5 (7.9) years, were predominantly Black and 53.8% were male. After one year, 4 (7.7%, 95% CI: 2.1-18.7%) developed hypertension. Blood pressure, weight and body mass index (BMI) significantly increased (p<0.05) by 12 months. In Canada, 486 HIV-positive and normotensive subjects were enrolled; 303 (62.3%) initiated antiretroviral therapy and 183 (37.7%) remained ARV-naive during the study. Subjects were predominantly White (>70%) and male (>75%) with a mean age (SD) of 45.1 (10.0) years. Nine-year incidence of hypertension for ARV-treated and ARV-naïve cohorts was 12.5% (95% CI: 8.8-16.2%) and 8.2% (95% CI: 4.2-12.2%) respectively. Hypertensive individuals were significantly older, heavier, and more likely to have abnormal lipids. In the final multivariable Cox regression model for incident hypertension, antiretroviral therapy was associated with a 125% increased risk (p=0.018), adjusted for age, sex and race. Individuals >50 compared to <40 years had an increased risk of approximately>280% (p=0.003). Current weight (10 kg increments) was associated with a 37% increased risk (p<0.001). An inverse association between CD4-T-lymphocyte count change and hypertension was observed: a positive change of >500 cell/ml compared to a decrease in CD4-T-lymphocyte count was associated with an 80% lower risk (p=0.032). <strong> </strong> <strong>Conclusion: </strong>Hypertension is common among HIV-positive individuals in Tanzania and Canada and expected to increase over time. Hypertension is associated with antiretroviral therapy; however, further research is needed to understand this relationship.<strong> </strong>
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".