Question

Do ARVs increase the risk of hypertension, especially in women?

28 March 2024. Related: All topics, Pregnancy, Side effects.

Do ARVS cause hypertension in people living with HIV?

I am also particularly interested in the impact on women living with HIV and would appreciate it if you could share some examples of studies that have been conducted in women which show that ARVs do cause hypertension in women.

Answer

Answer: Simon Collins

Hi there

Thanks for a great question.

The short answer is that most HIV meds do not seem to increase the risk of hypertension. However, some more recent HIV meds including integrase inhibitors (INSTIs) can increase the risk, including in women.

A longer answer is that the D:A:D study showed that most HIV meds do not increase blood pressure (also called hypertension or HT). This was a very large study over many year that adjusted for all the other factors that are linked to HT.

These include family history, having diabetes or kidney disease, being older than 65, being overweight weight, and having a Black or South Asian background. HIV factors like a low CD4 count can also be involved. This shows that it can also be difficult to link HT to treatment, becasue of all the other factors involved.

However, D:A:D was also before integrase inhibitors were available or widely used.

Several more recent studies including RESPOND have suggested that integrase inhibitors including dolutegravir might be linked to HT. Some studies report that risks are higher in men. Some studies report risks during pregnancy can be higher, including one from CROI 2024 listed below.

A second African study during pregnancy found dolutegravir has a higher link to HT than efavirenz, but that rates of HT were higher in HIV negative women compared to HIV positive women on ART.

Perhaps just as important as finding out the link to specific drugs is the the need to monitor and diagnose HT so it can be managed and treated.

Study links

Hatleberg CI et al. Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group. Association between exposure to antiretroviral drugs and the incidence of hypertension in HIV-positive persons. HIV Med. 2018 Oct;19(9):605-618. doi: 10.1111/hiv.12639. (18 July 2018).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169998/

Byonanebye DM et al. Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium. HIV Medicine. (1 March 2022).
https://doi.org/10.1111/hiv.13273

Uwanyirigira D et al. Prevalence and Factors Associated with Hypertension Among HIV Positive Patients on Antiretroviral Therapy: A Hospital-Based Cross-Sectional Study in Rwanda. Vasc Health Risk Manag. 2023 Dec 27;19:857-870. doi: 10.2147/VHRM.S442108.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10757801/