Yonsei Med J.  2018 Dec;59(10):1245-1252. 10.3349/ymj.2018.59.10.1245.

Hypertension Risk with Abacavir Use among HIV-Infected Individuals: A Nationwide Cohort Study

• Kim J
• Bang JH
• Shin JY
• Yang BR
• Lee J
• Park BJ

• KMID: 2426340
• DOI: http://doi.org/10.3349/ymj.2018.59.10.1245

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.

Keyword

Hypertension; abacavir; HIV; antiretroviral therapy; epidemiology

MeSH Terms

Anti-Bacterial Agents
Cardiovascular Diseases
Cohort Studies*
Epidemiology
Follow-Up Studies
HIV
Humans
Hypertension*
Incidence
Male
Proportional Hazards Models
Tertiary Care Centers
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Selection of the study population. ART, antiretroviral treatment; NRTI, nucleoside analogue reverse transcriptase inhibitors; PEP, post-exposure prophylaxis.

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