Blood pressure increases are associated with weight gain and not antiretroviral regimen or kidney function: a secondary analysis from the ADVANCE trial in South Africa.
Humans
Male
Female
South Africa
HIV Infections
/ drug therapy
Adult
Middle Aged
Tenofovir
/ therapeutic use
Weight Gain
/ drug effects
Hypertension
/ drug therapy
Blood Pressure
/ drug effects
Pyridones
/ therapeutic use
Piperazines
/ therapeutic use
Oxazines
/ therapeutic use
Heterocyclic Compounds, 3-Ring
/ therapeutic use
Glomerular Filtration Rate
/ drug effects
Alanine
/ therapeutic use
Anti-HIV Agents
/ therapeutic use
HIV
dolutegravir
hypertension
kidney function
obesity
tenofovir alafenamide
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
Jul 2024
Jul 2024
Historique:
received:
01
12
2023
accepted:
26
04
2024
medline:
9
7
2024
pubmed:
9
7
2024
entrez:
9
7
2024
Statut:
ppublish
Résumé
Recent evidence has raised questions about whether newer HIV treatment regimens, including dolutegravir (DTG) and tenofovir alafenamide (TAF), are associated with increases in blood pressure (BP). We assessed changes in BP by treatment regimen and evaluated the relative contribution of kidney function and weight gain to these changes among participants in the ADVANCE phase-3 trial clinical trial in South Africa (study dates: January 2017-February 2022). Our primary outcome of interest was a change in systolic BP (SBP) at 96 and 192 weeks, among those not receiving antihypertensive medication. The secondary outcome was treatment-emergent hypertension at these same time points, defined as BP ≥140/90 mmHg on two occasions, or initiation of antihypertensive medication after week 4 among individuals without hypertension at enrolment. We used linear regression to evaluate the relationship between change in estimated glomerular filtration rate (eGFR) and change in SBP; and Poisson regression to evaluate the relationship between change in eGFR and treatment-emergent hypertension at each time point. All models were adjusted for age, sex, treatment group and change in body mass index (BMI). Over 96 weeks, the average changes in SBP were 1.7 mmHg (95% CI: 0.0-3.4), -0.5 mmHg (95% CI: -2.2 to 1.7) and -2.1 mmHg (95% CI: -3.8 to 0.4) in the TAF/emtricitabine (FTC)/DTG, tenofovir disoproxil fumarate (TDF)/FTC/DTG and TDF/FTC/efavirenz (EFV) groups, respectively. This difference was significant for the TAF/FTC/DTG compared to the TDF/FTC/EFV group (p = 0.002). Over 96 weeks, 18.2% (95% CI: 13.4-22.9), 15.4% (95% CI: 11.0-19.9) and 13.3% (95% CI: 8.9-17.6) of participants developed treatment-emergent hypertension, respectively. In adjusted models, there was no significant relationship between change in eGFR and either outcome. Change in BMI was significantly associated with an increase in SBP, while age was associated with an increased risk of treatment-emergent hypertension. Adjustment for BMI also mitigated the unadjusted relationship between HIV treatment regimen and SBP where present. In the ADVANCE cohort, weight gain and age accounted for increases in BP and risk of treatment-emergent hypertension. HIV treatment programmes may need to integrate the management of obesity and hypertension into routine care. NCT03122262.
Substances chimiques
Tenofovir
99YXE507IL
Pyridones
0
Piperazines
0
dolutegravir
DKO1W9H7M1
Oxazines
0
Heterocyclic Compounds, 3-Ring
0
tenofovir alafenamide
EL9943AG5J
Alanine
OF5P57N2ZX
Anti-HIV Agents
0
Banques de données
ClinicalTrials.gov
['NCT03122262']
Types de publication
Journal Article
Randomized Controlled Trial
Clinical Trial, Phase III
Langues
eng
Sous-ensembles de citation
IM
Pagination
e26268Subventions
Organisme : NIDDK NIH HHS
ID : K01DK116929
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23125162
Pays : United States
Organisme : SA MRC, UNITAID, USAID, ViiV Healthcare
Informations de copyright
© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
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