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Session 102 Poster Abstracts
Cardiovascular Complications: Risk Factors, Incidence, Prevalence, and Outcomes
Tuesday, 1:30 - 3:30 pm
Poster Hall


741
Hypertension in HIV-infected Women Related to HAART: Women's Interagency HIV Study
A Khalsa*1, R Karim1, W Mack1, H Minkoff2, M Cohen3, M Young4, K Anastos5, R Greenblatt6, S Gange7, A Levine1, and Metabolic Working Group
1Univ. of Southern California, Los Angeles, USA; 2New York State Univ., Brooklyn, USA; 3Cook County Hosp., Chicago, IL, USA; 4Georgetown Univ., Washington, DC, USA; 5Montefiore Med. Ctr., Bronx, NY, USA; 6Univ. of California, San Francisco, USA; and 7Johns Hopkins Univ., Baltimore, MD, USA

Background:  Since the advent of HAART lipodystrophy has become commonplace. Hypertension has also been increasingly observed, possibly as part of an overall metabolic syndrome. This analysis seeks to assesses the occurrence of hypertension and its association with HAART.

Methods:  The WIHS is an ongoing, prospective, multi-site U.S. cohort study of HIV+ve women and HIV-ve women at risk. Study visits occur every 6 months. This analysis evaluated the original cohort of 2046 HIV+ve and 564 HIV-ve women through visit 16.  Hypertension was defined as systolic  blood pressure >140 mmHg or diastolic blood pressure >90 mmHg on physical exam during a routine study visit or the taking of antihypertensive medications. Generalized estimating equation (GEE) models were fitted to determine the predictors of incident hypertension among the HIV+ cases using both univariate and multivariate analyses. Different definitions of antiretroviral therapy were tested independently. All models were fitted using PROC GENMOD in SAS, version 8.0.

Results:  The baseline prevalence rate of hypertension was 19% for both the HIV+ve and HIV-ve women. The overall incidence rate was not significantly different between the HIV+ve and HIV-ve women (47% vs 46%, respectively). Both the univariate and multivariate models found increasing age, African American race, lower education level, smoking, increasing body mass index (30+), and HAART use (RR 1.26, 95% CI:  1.1 to 1.48, p = 0.01) to be significantly associated with hypertension, whereas current pregnancy, and AZT monotherapy (RR 0.50, 95% CI:  0.35 to 0.72, p = 0.0001) showed protective effects. In the univariate analyses lower CD4 count and higher viral load were associated with a reduced risk for developing hypertension, although these were not significant in the multivariate model. There was a time-dependent relationship between the number of HAART intervals and hypertension (RR 1.32, 95% CI:  1.11 to 1.58, p = 0.02 for one 6-month interval on HAART; RR 1.36, 95% CI:  1.12 to 1.65, p = 0.02 for 2 intervals; and RR 1.51, 95% CI:  1.30 to 1.75, p <0.0001, for > 3 intervals on HAART).

Conclusions:  This analysis confirms the increasing incidence of hypertension among the women in the WIHS cohort, and suggests that this is independent of HIV disease stage, and is possibly related to HAART use. This evaluation also suugests a possible protective effect of AZT use, although its' mechanism remains to be determined.

Keywords: Hypertension; Women; HIV