Background
The literature on the association between classes of antiretrovirals (ARV) and hypertension (HTN) is conflicting, and very little has been published at the agent level. We compared the rates of incident HTN across combinations of common ARVs among people with HIV in routine clinical care in the US-based OPERA cohort.
Methods
Adults with HIV in the OPERA cohort starting a new 2- or 3-drug regimen (DR) between 01JAN2016 and 31DEC2022 were included if they had no evidence of HTN (no HTN diagnosis or prescription for antihypertensive) and either normal blood pressure (BP) (nBP; systolic BP [SBP] <120 mmHg, diastolic BP [DBP] < 80 mmHg) or normal & elevated BP (n+eBP; SBP <140 mmHg; DBP <90 mmHg) at regimen start. Incident HTN was defined as (a) two consecutive SBP ≥140 mmHg or DBP ≥90 mmHg, (b) new HTN diagnosis or (c) new antihypertensive prescription. We estimated adjusted incidence rate ratios (aIRR; multivariate Poisson regression) comparing regimens of dolutegravir (DTG) 3DR with or without tenofovir alafenamide (TAF), DTG/lamivudine (3TC) 2DR, bictegravir/emtricitabine/TAF (B/F/TAF), or boosted darunavir (bDRV) 3DR with or without TAF. Analyses were conducted among those with n+eBP and the subset with nBP, stratified by prior ART experience.
Results
There were 7572 ART-naïve people with n+eBP (3220 nBP); 4% aged 55+, 13% female, 53% Black, 14% obese, 83% eGFR ≥90, 6% viral load ≥1M. There were 3428 ART-experienced people with n+eBP (1142 nBP); 14% aged 55+, 18% female, 39% Black, 19% obese, 61% eGFR ≥90, 58% viral load <50. Incidence rates of HTN approximately doubled in those with n+eBBP for both ART-naïve and ART-experienced individuals (Figure). However, there was no statistically significant association between regimen and rate of HTN in ART-naïve or ART-experienced individuals, regardless of baseline BP (Figure).
Conclusions
In this real-world assessment of people with HIV with either n+eBP or nBP at regimen start, no statistically significant difference was observed between common core ARV agents with or without TAF and the rate of incident HTN in ART-naïve or ART experienced individuals. Among commonly used modern ART regimens, specific antiretroviral combinations do not appear to be a driving factor in the development of HTN in this large and diverse cohort of people with HIV in the US.
Table or Figure
