D-Dimer levels and traditional risk factors are associated with incident hypertension among HIV-infected individuals initiating antiretroviral therapy in Uganda

Samson Okello, 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 Bangsberg, A. Rain Mocello, Jeffrey N. Martin, Peter W. Hunt, Mark J. Siedner

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)396-402
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume73
Issue number4
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Uganda
HIV
Blood Pressure
Hypertension
Odds Ratio
Kynurenine
Therapeutics
Tryptophan
Logistic Models
fibrin fragment D
CD4 Lymphocyte Count
Lipopolysaccharides
Linear Models
Interleukin-6
Biomarkers
Inflammation

Keywords

  • Africa
  • antiretroviral therapy
  • D-dimer
  • hypertension
  • immune activation

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

D-Dimer levels and traditional risk factors are associated with incident hypertension among HIV-infected individuals initiating antiretroviral therapy in Uganda. / Okello, Samson; Asiimwe, Stephen B.; Kanyesigye, Michael; Muyindike, Winnie R.; Boum, Yap; Mwebesa, Bosco B.; Haberer, Jessica E.; Huang, Yong; Williams, Kenneth; Burdo, Tricia H.; Tracy, Russell P.; Bangsberg, David; Mocello, A. Rain; Martin, Jeffrey N.; Hunt, Peter W.; Siedner, Mark J.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 73, No. 4, 01.12.2016, p. 396-402.

Research output: Contribution to journalArticle

Okello, S, Asiimwe, SB, Kanyesigye, M, Muyindike, WR, Boum, Y, Mwebesa, BB, Haberer, JE, Huang, Y, Williams, K, Burdo, TH, Tracy, RP, Bangsberg, D, Mocello, AR, Martin, JN, Hunt, PW & Siedner, MJ 2016, 'D-Dimer levels and traditional risk factors are associated with incident hypertension among HIV-infected individuals initiating antiretroviral therapy in Uganda', Journal of Acquired Immune Deficiency Syndromes, vol. 73, no. 4, pp. 396-402. https://doi.org/10.1097/QAI.0000000000001074
Okello, Samson ; Asiimwe, Stephen B. ; Kanyesigye, Michael ; Muyindike, Winnie R. ; Boum, Yap ; Mwebesa, Bosco B. ; Haberer, Jessica E. ; Huang, Yong ; Williams, Kenneth ; Burdo, Tricia H. ; Tracy, Russell P. ; Bangsberg, David ; Mocello, A. Rain ; Martin, Jeffrey N. ; Hunt, Peter W. ; Siedner, Mark J. / D-Dimer levels and traditional risk factors are associated with incident hypertension among HIV-infected individuals initiating antiretroviral therapy in Uganda. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 73, No. 4. pp. 396-402.
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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.",
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AU - Okello, Samson

AU - Asiimwe, Stephen B.

AU - Kanyesigye, Michael

AU - Muyindike, Winnie R.

AU - Boum, Yap

AU - Mwebesa, Bosco B.

AU - Haberer, Jessica E.

AU - Huang, Yong

AU - Williams, Kenneth

AU - Burdo, Tricia H.

AU - Tracy, Russell P.

AU - Bangsberg, David

AU - Mocello, A. Rain

AU - Martin, Jeffrey N.

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N2 - 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.

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