{"id":222308,"date":"2023-02-17T20:11:04","date_gmt":"2023-02-18T01:11:04","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?post_type=bu-article&#038;p=222308"},"modified":"2023-02-18T16:53:08","modified_gmt":"2023-02-18T21:53:08","slug":"hiv-drug-may-be-linked-to-increased-risk-of-hypertension","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2023\/hiv-drug-may-be-linked-to-increased-risk-of-hypertension\/","title":{"rendered":"HIV Drug May Be Linked to Increased Risk of Hypertension"},"content":{"rendered":"\t<div class=\"wp-block-editorial-leadin sphnews-block-editorial-leadin is-style-text-over-image has-media has-box has-media-focus-center-middle has-text-position-x-left has-dark-theme\">\n\t\t<div class=\"container-lockup\">\n\n\t\t\t<div class=\"wp-block-leadin-media\">\n\t\t\t\t\n\t\t\t\t<img width=\"2560\" height=\"1708\" src=\"\/sph\/files\/2023\/02\/hiv-scaled.jpg\" class=\"\" alt=\"A doctor check&#039;s patient&#039;s blood pressure with arm cuff\" loading=\"lazy\" srcset=\"https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-scaled.jpg 2560w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-636x424.jpg 636w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-1024x683.jpg 1024w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-768x512.jpg 768w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-1536x1025.jpg 1536w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-2048x1367.jpg 2048w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-755x504.jpg 755w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-1499x1000.jpg 1499w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-900x601.jpg 900w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-450x300.jpg 450w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-600x400.jpg 600w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-1920x1281.jpg 1920w, https:\/\/www.bu.edu\/sph\/files\/2023\/02\/hiv-1200x801.jpg 1200w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\n\t\t\t\n\t\t\t\t<div class=\"container-words-outer\">\n\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"container-words-inner has-opacity-90\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"wp-prepress-tag\">antiretroviral therapy<\/span>\n\t\t\t\t\t\t\t\t<h1 class=\"head\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tHIV Drug May Be Linked to Increased Risk of Hypertension\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/h1>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"deck\">People living with HIV gained more weight and increased their risk of hypertension after switching from the\u00a0antiviral therapy drug\u00a0efavirenz to the WHO-recommended drug dolutegravir, compared to patients who remained on efavirenz.<\/h4>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\n\t\t<\/div>\n\n\t\t\n\t<\/div>\n\n\t\n<div class=\"wp-prepress-component-metabar sphnews-prepress-layout-metabar\">\n\t<div class=\"wp-prepress-component-metabar-wrapper\">\n\t\t\t\t\t<div class=\"wp-prepress-component-metabar-date\">February 17, 2023<\/div>\n\t\t\n\t\t\t\t<div class=\"wp-prepress-component-metabar-credits\">\n\t\t\t\t\t\t\t\t<ul data-credit-type=\"By\">\n\t\t\t\t\t\t<li><a href=\"https:\/\/www.bu.edu\/sph\/news\/authors\/jillian-mckoy\/\">Jillian McKoy<\/a><\/li>\n\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"wp-prepress-component-metabar-share js-bu-prepress-share-tools\">\n\t\t\t<span class=\"icon-twitter\"><span>Twitter<\/span><\/span>\n\t\t\t<span class=\"icon-facebook\"><span>Facebook<\/span><\/span>\n\t\t\t<span class=\"icon-action\"><\/span>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t\n\n\n<p>In 2019, the World Health Organization&nbsp;<a href=\"https:\/\/www.who.int\/news\/item\/22-07-2019-who-recommends-dolutegravir-as-preferred-hiv-treatment-option-in-all-populations\">formally recommended<\/a> the drug dolutegravir&nbsp;(DTG) as the preferred antiretroviral therapy (ART) for people living with HIV in low and middle-income countries, citing that it is more effective and tolerable, less costly, and less prone to developing drug resistance than the previously recommended first-line treatment efavirenz (EFV).<\/p>\n\n\n\n<p>Since then, several clinical trials have shown that DTG&nbsp;is associated with substantial&nbsp;weight gain among people taking it, compared to people who take EFV.&nbsp;<\/p>\n\n\n\n<p>A new study led by a School of Public Health researcher has confirmed these findings about DTG and weight gain, and also found that people living with HIV who take DTG may also have a higher risk of developing high blood pressure.<\/p>\n\n\n\n<p><a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(23)00013-5\/fulltext\">Published in&nbsp;<em>eClinical Medicine<\/em><\/a>, a journal of&nbsp;<em>The Lancet<\/em>, the study found that&nbsp;patients on&nbsp;ART gained on&nbsp;average 1.78 kg (3.92 pounds) in 12 months&nbsp;after switching from EFV to DTG, compared to patients who remained on EFV. The results&nbsp;also showed that patients taking DTG increased their risk of developing hypertension by 14 percentage points, compared to patients who remained on EFV.<\/p>\n\n\n\n<p>As DTG will likely remain the drug of choice in first-line&nbsp;ART in low and middle-income countries, the researchers say that more studies are needed to understand whether weight gain from DTG is sustained over time, and if it is indeed linked to increased risk for hypertension and other non-communicable diseases, such as type 2 diabetes.&nbsp;<\/p>\n\n\n\n<p>\u201cThe gain in weight was expected\u2014this has been described in many other studies, and appears to be a weight-gain mitigating effect of efavirenz in a substantial number of patients, rather than dolutegravir causing weight gain,\u201d says study lead author&nbsp;<a href=\"https:\/\/www.bu.edu\/sph\/profile\/alana-brennan\/\">Alana Brennan<\/a>, assistant professor of global health. \u201cThe blood pressure rise data is less clear, and in some ways more worrying if linked to the drug, as it appears fairly quickly after exposure. This needs to be carefully confirmed, and prior randomized controlled trials&nbsp;and observational evidence should be scrutinized before any conclusions are made.\u201d<\/p>\n\n\n\n<p>For the study, Brennan and colleagues from SPH and the&nbsp;University of the Witwatersrand in Johannesburg, South Africa compared absolute and percentage weight change and hypertension risk among Black&nbsp;patients living with HIV who were of African descent, ages 16 and older, and who began their ART regimen between January 2010 and December 2020. The team matched 794 patients who switched from DTG to EFV, to 794 patients who remained on EFV, and examined a range of factors including sex, age, first ART regimen, number of months on ART, haemoglobin, body mass index (BMI), blood pressure, viral load, and CD4 count.<\/p>\n\n\n\n<p>In&nbsp;addition to the average increase in weight among patients taking DTG, the findings showed that, regardless of whether patients switched to DTG, patients who had a lower BMI (less than 30), were younger than 50 years old, and received&nbsp;ART treatment for less than a year gained more weight than those who had higher BMI, were 50 or older, or whose regimen extended beyond 12 months, respectively.<\/p>\n\n\n\n<p>The team also observed that patients with existing high blood pressure at the start of the study had an increased risk of hypertension 12 months later. Female patients also had a slightly higher risk of developing high blood pressure, compared to male patients.<\/p>\n\n\n\n<p>The researchers say additional clinical trials will provide deeper insight into possible effects of DTG on long-term chronic illnesses among people living with HIV in low and middle-income countries. In the US, the drug&nbsp;bictegravir (BIC) is the preferred&nbsp;ART, but both BIC&nbsp;and DTG treatment have similar chemical compositions, side effects, and resistance, so&nbsp;\u201cit will be important to scrutinize their databases in the same way,\u201d&nbsp;says study senior author&nbsp;<a href=\"https:\/\/www.wits.ac.za\/staff\/academic-a-z-listing\/v\/willemventerwitsacza\/\" target=\"_blank\" rel=\"noreferrer noopener\">Francois Venter<\/a>, research professor in the&nbsp;Faculty of Health Sciences at the University of the Witwatersrand.&nbsp;<\/p>\n\n\n\n<p>But the team cautions not to dismiss the effectiveness of DTG as a life-saving HIV treatment.<\/p>\n\n\n\n<p>\u201cIt is important not to leap to conclusions\u2014this class of drugs confer huge benefits in terms of side effects and resistance benefits,\u201d Venter says. \u201cBut we need to interrogate existing datasets quickly\u2014blood pressure is routinely collected in pretty much everyone, so we should be able to quickly see whether this is something to worry about or not.\u201d<\/p>\n\n\n\n<p>At SPH, the study was coauthored by <a href=\"https:\/\/www.bu.edu\/sph\/profile\/sydney-rosen\/\">Sydney Rosen<\/a>, research professor of global health, <a href=\"https:\/\/www.linkedin.com\/in\/emmakileel\/\">Emma Kileel<\/a>, PhD student in Epidemiology, <a href=\"https:\/\/www.bu.edu\/sph\/profile\/andrew-stokes\/\">Andrew Stokes<\/a>, assistant professor of global health, and <a href=\"https:\/\/www.bu.edu\/sph\/profile\/matthew-fox\/\">Matthew Fox<\/a>, professor of epidemiology and global health. The study was also coauthored by <a rel=\"noreferrer noopener\" href=\"https:\/\/www.heroza.org\/staffmembers\/cornelius-nattey\/\" target=\"_blank\">Cornelius Nattey<\/a> and <a rel=\"noreferrer noopener\" href=\"https:\/\/www.wits.ac.za\/staff\/academic-a-z-listing\/m\/mas\/mhairimaskewwitsacza\/\" target=\"_blank\">Mhairi Maskew<\/a>, both reserchers in the Health Economics and Epidemiology Research Office at the University of the Witwatersrand.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In 2019, the World Health Organization&nbsp;formally recommended the drug dolutegravir&nbsp;(DTG) as the preferred antiretroviral therapy (ART) for people living with HIV in low and middle-income countries, citing that it is more effective and tolerable, less costly, and less prone to developing drug resistance than the previously recommended first-line treatment efavirenz (EFV). Since then, several clinical [&hellip;]<\/p>\n","protected":false},"author":15205,"featured_media":222312,"comment_status":"closed","ping_status":"closed","template":"","meta":{"bu_prepress_billboard":"","_bu_prepress_primary_term":"antiretroviral therapy","_bu_prepress_primary_term_manual":""},"tags":[2011,2265,2364,1711,4080,3887],"bu-publication":[3516],"sphnews-article-category":[3519,3531,3532,3540],"sphnews-topic":[],"bu_edition":[],"media_type":[],"profile_tax":[219,1402,351,362],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/222308"}],"collection":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article"}],"about":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/types\/bu-article"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/users\/15205"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/comments?post=222308"}],"version-history":[{"count":13,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/222308\/revisions"}],"predecessor-version":[{"id":222375,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-article\/222308\/revisions\/222375"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media\/222312"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media?parent=222308"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/tags?post=222308"},{"taxonomy":"bu-publication","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu-publication?post=222308"},{"taxonomy":"sphnews-article-category","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-article-category?post=222308"},{"taxonomy":"sphnews-topic","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/sphnews-topic?post=222308"},{"taxonomy":"bu_edition","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/bu_edition?post=222308"},{"taxonomy":"media_type","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/media_type?post=222308"},{"taxonomy":"profile_tax","embeddable":true,"href":"https:\/\/www.bu.edu\/sph\/wp-json\/wp\/v2\/profile_tax?post=222308"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}