Hypertension Risk with Abacavir Use among HIV-Infected Individuals: A Nationwide Cohort Study.
10.3349/ymj.2018.59.10.1245
- Author:
Jungmee KIM
1
;
Ji Hwan BANG
;
Ju Young SHIN
;
Bo Ram YANG
;
Joongyub LEE
;
Byung Joo PARK
Author Information
1. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. bjpark@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Hypertension;
abacavir;
HIV;
antiretroviral therapy;
epidemiology
- MeSH:
Anti-Bacterial Agents;
Cardiovascular Diseases;
Cohort Studies*;
Epidemiology;
Follow-Up Studies;
HIV;
Humans;
Hypertension*;
Incidence;
Male;
Proportional Hazards Models;
Tertiary Care Centers
- From:Yonsei Medical Journal
2018;59(10):1245-1252
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: A high risk of cardiovascular disease (CVD) is reported for HIV-infected individuals. While a link between abacavir and CVD risk is suggested, an association between abacavir and hypertension remains unclear. This study evaluated hypertension risk with abacavir use in comparison to non-abacavir antiretroviral treatment (ART). MATERIALS AND METHODS: From a nationwide cohort of HIV-infected individuals on their initial ART, 6493 who were free of hypertension at baseline were analyzed. The use of ART was treated as a time-varying covariate measured as a daily unit. Incidence rate of hypertension was calculated, and Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) with 95% confidence interval (CI) of incident hypertension overall and among subgroups. RESULTS: From the 6493 participants, 24072 person-years (PY) of follow-up were contributed during 2008–2016. The incidence rates of hypertension were 4.6 and 3.6 per 100 PY for abacavir and non-abacavir ART users, respectively. The population attributable fraction of abacavir use on hypertension was 12%. Abacavir exposure did not elevate the risk of hypertension among overall study population [HR, 1.2 (95% CI, 1.0–1.4), p=0.061]. However, those with poor ART adherence, defined as a medication possession ratio < 50% [HR, 1.9 (95% CI, 1.5–2.4), p < 0.0001] or requiring prophylactic antibiotics [HR, 1.2 (95% CI, 1.0–1.3), p=0.023], were at risk of hypertension induced by abacavir, as were men, individuals aged ≥40 years, and patients visiting tertiary hospitals in urban areas. CONCLUSION: When present, poor ART adherence, requiring prophylactic antibiotics, male sex, and older age may warrant additional concern for hypertension in patients treated with abacavir.
