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Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study

BACKGROUND: The epidemics of HIV and hypertension are converging in sub-Saharan Africa. Due to antiretroviral therapy (ART), more HIV-infected adults are living longer and gaining weight, putting them at greater risk for hypertension and kidney disease. The relationship between hypertension, kidney...

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Autores principales: Peck, Robert N, Shedafa, Rehema, Kalluvya, Samuel, Downs, Jennifer A, Todd, Jim, Suthanthiran, Manikkam, Fitzgerald, Daniel W, Kataraihya, Johannes B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243281/
https://www.ncbi.nlm.nih.gov/pubmed/25070128
http://dx.doi.org/10.1186/s12916-014-0125-2
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author Peck, Robert N
Shedafa, Rehema
Kalluvya, Samuel
Downs, Jennifer A
Todd, Jim
Suthanthiran, Manikkam
Fitzgerald, Daniel W
Kataraihya, Johannes B
author_facet Peck, Robert N
Shedafa, Rehema
Kalluvya, Samuel
Downs, Jennifer A
Todd, Jim
Suthanthiran, Manikkam
Fitzgerald, Daniel W
Kataraihya, Johannes B
author_sort Peck, Robert N
collection PubMed
description BACKGROUND: The epidemics of HIV and hypertension are converging in sub-Saharan Africa. Due to antiretroviral therapy (ART), more HIV-infected adults are living longer and gaining weight, putting them at greater risk for hypertension and kidney disease. The relationship between hypertension, kidney disease and long-term ART among African adults, though, remains poorly defined. Therefore, we determined the prevalences of hypertension and kidney disease in HIV-infected adults (ART-naive and on ART >2 years) compared to HIV-negative adults. We hypothesized that there would be a higher hypertension prevalence among HIV-infected adults on ART, even after adjusting for age and adiposity. METHODS: In this cross-sectional study conducted between October 2012 and April 2013, consecutive adults (>18 years old) attending an HIV clinic in Tanzania were enrolled in three groups: 1) HIV-negative controls, 2) HIV-infected, ART-naive, and 3) HIV-infected on ART for >2 years. The main study outcomes were hypertension and kidney disease (both defined by international guidelines). We compared hypertension prevalence between each HIV group versus the control group by Fisher’s exact test. Logistic regression was used to determine if differences in hypertension prevalence were fully explained by confounding. RESULTS: Among HIV-negative adults, 25/153 (16.3%) had hypertension (similar to recent community survey data). HIV-infected adults on ART had a higher prevalence of hypertension (43/150 (28.7%), P = 0.01) and a higher odds of hypertension even after adjustment (odds ratio (OR) = 2.19 (1.18 to 4.05), P = 0.01 in the best model). HIV-infected, ART-naive adults had a lower prevalence of hypertension (8/151 (5.3%), P = 0.003) and a lower odds of hypertension after adjustment (OR = 0.35 (0.15 to 0.84), P = 0.02 in the best model). Awareness of hypertension was ≤25% among hypertensive adults in all three groups. Kidney disease was common in all three groups (25.6% to 41.3%) and strongly associated with hypertension (P <0.001 for trend); among hypertensive participants, 50/76 (65.8%) had microalbuminuria and 20/76 (26.3%) had an estimated glomerular filtration rate (eGFR) <60 versus 33/184 (17.9%) and 16/184 (8.7%) participants with normal blood pressure. CONCLUSIONS: HIV-infected adults on ART >2 years had two-fold greater odds of hypertension than HIV-negative controls. HIV-infected adults with hypertension were rarely aware of their diagnosis but often have evidence of kidney disease. Intensive hypertension screening and education are needed in HIV-clinics in sub-Saharan Africa. Further studies should determine if chronic, dysregulated inflammation may accelerate hypertension in this population.
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spelling pubmed-42432812014-11-26 Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study Peck, Robert N Shedafa, Rehema Kalluvya, Samuel Downs, Jennifer A Todd, Jim Suthanthiran, Manikkam Fitzgerald, Daniel W Kataraihya, Johannes B BMC Med Research Article BACKGROUND: The epidemics of HIV and hypertension are converging in sub-Saharan Africa. Due to antiretroviral therapy (ART), more HIV-infected adults are living longer and gaining weight, putting them at greater risk for hypertension and kidney disease. The relationship between hypertension, kidney disease and long-term ART among African adults, though, remains poorly defined. Therefore, we determined the prevalences of hypertension and kidney disease in HIV-infected adults (ART-naive and on ART >2 years) compared to HIV-negative adults. We hypothesized that there would be a higher hypertension prevalence among HIV-infected adults on ART, even after adjusting for age and adiposity. METHODS: In this cross-sectional study conducted between October 2012 and April 2013, consecutive adults (>18 years old) attending an HIV clinic in Tanzania were enrolled in three groups: 1) HIV-negative controls, 2) HIV-infected, ART-naive, and 3) HIV-infected on ART for >2 years. The main study outcomes were hypertension and kidney disease (both defined by international guidelines). We compared hypertension prevalence between each HIV group versus the control group by Fisher’s exact test. Logistic regression was used to determine if differences in hypertension prevalence were fully explained by confounding. RESULTS: Among HIV-negative adults, 25/153 (16.3%) had hypertension (similar to recent community survey data). HIV-infected adults on ART had a higher prevalence of hypertension (43/150 (28.7%), P = 0.01) and a higher odds of hypertension even after adjustment (odds ratio (OR) = 2.19 (1.18 to 4.05), P = 0.01 in the best model). HIV-infected, ART-naive adults had a lower prevalence of hypertension (8/151 (5.3%), P = 0.003) and a lower odds of hypertension after adjustment (OR = 0.35 (0.15 to 0.84), P = 0.02 in the best model). Awareness of hypertension was ≤25% among hypertensive adults in all three groups. Kidney disease was common in all three groups (25.6% to 41.3%) and strongly associated with hypertension (P <0.001 for trend); among hypertensive participants, 50/76 (65.8%) had microalbuminuria and 20/76 (26.3%) had an estimated glomerular filtration rate (eGFR) <60 versus 33/184 (17.9%) and 16/184 (8.7%) participants with normal blood pressure. CONCLUSIONS: HIV-infected adults on ART >2 years had two-fold greater odds of hypertension than HIV-negative controls. HIV-infected adults with hypertension were rarely aware of their diagnosis but often have evidence of kidney disease. Intensive hypertension screening and education are needed in HIV-clinics in sub-Saharan Africa. Further studies should determine if chronic, dysregulated inflammation may accelerate hypertension in this population. BioMed Central 2014-07-29 /pmc/articles/PMC4243281/ /pubmed/25070128 http://dx.doi.org/10.1186/s12916-014-0125-2 Text en © Peck et al. licensee BioMed Central 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Peck, Robert N
Shedafa, Rehema
Kalluvya, Samuel
Downs, Jennifer A
Todd, Jim
Suthanthiran, Manikkam
Fitzgerald, Daniel W
Kataraihya, Johannes B
Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study
title Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study
title_full Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study
title_fullStr Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study
title_full_unstemmed Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study
title_short Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study
title_sort hypertension, kidney disease, hiv and antiretroviral therapy among tanzanian adults: a cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243281/
https://www.ncbi.nlm.nih.gov/pubmed/25070128
http://dx.doi.org/10.1186/s12916-014-0125-2
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