HIV阳性者高血压发病密度及影响因素的系统综述

何春燕; 徐小慧; 何纳; 丁盈盈

doi:10.16462/j.cnki.zhjbkz.2024.06.016

HIV阳性者高血压发病密度及影响因素的系统综述

doi: 10.16462/j.cnki.zhjbkz.2024.06.016

何春燕^{1, 2},
徐小慧²,
何纳¹,
丁盈盈^1, ,

1.
复旦大学公共卫生学院流行病学教研室，公共卫生安全教育部重点实验室，上海 200032
2.
上海市疾病预防控制中心艾滋病性病麻风病防治科，上海 200336

基金项目:

上海市自然科学基金 21ZR1403800

国家重点研发计划 2022YFC2304901

详细信息

通讯作者:
丁盈盈，E-mail：dingyy@fudan.edu.cn

中图分类号: R512.91
计量
- 文章访问数: 89
- HTML全文浏览量: 19
- PDF下载量: 18
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-05
- 修回日期: 2024-05-07
- 网络出版日期: 2024-07-13
- 刊出日期: 2024-06-10

Systematic review of the incidence and risk factors of hypertension among HIV-positive individuals

HE Chunyan^{1, 2},
XU Xiaohui²,
HE Na¹,
DING Yingying^{1
, ,}

1.
School of Public Health, Fudan University, Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China
2.
Department of HIV/AIDS, Sexually Transmitted Infections, and Leprosy Prevention and Treatment, Shanghai Municipal Center for Disease Control & Prevention, Shanhai 200336, China

Funds:

Shanghai Natural Science Foundation 21ZR1403800

National Key Research and Development Program of China 2022YFC2304901

More Information

Corresponding author: DING Yingying, E-mail: dingyy@fudan.edu.cn

摘要

摘要: 目的对人类免疫缺陷病毒(human immunodeficiency virus, HIV)阳性者高血压的发病密度和影响因素进行系统综述，旨在探索HIV阳性者发生高血压的影响因素及潜在的机制。方法通过中国知网、万方数据知识服务平台、PubMed、EMbase、Web of Science和Medline数据库系统检索HIV阳性者中高血压发病的相关文献，摘录基本信息、发病密度及影响因素。结果最终纳入20篇研究，研究包含北美洲国家5篇，非洲国家5篇，亚洲国家4篇，欧洲国家2篇，多中心研究4篇。HIV阳性者的高血压发病密度为26.0/1 000人年~320.1/1 000人年。HIV阳性者新发高血压的影响因素包括传统因素如年龄、性别、种族、BMI和腹部肥胖、糖尿病、肾病和血脂异常; 特异性的影响因素包括HIV感染时间、抗病毒治疗(antiretroviral therapy, ART)时长和ART药物等。结论 HIV阳性者的高血压发病密度较高，且地理差异较大。HIV阳性者新发高血压的传统影响因素作用比较确定，需要在HIV阳性者的生活方式中实施初级预防的策略和措施。然而，HIV和ART相关的影响因素对高血压发生的作用尚不清楚，需要进行前瞻性研究来确定HIV特异性因素的影响，以更好地了解HIV阳性者的高血压流行病学。
- 人类免疫缺陷病毒阳性 /
- 高血压 /
- 发病密度
Abstract: Objective To systematically review the incidence density and influencing factors of hypertension in HIV positive people in order to explore the potential mechanisms of hypertension in HIV positive individuals. Methods We search literature related to incident hypertension among HIV-positive individuals through CNKI, Wanfang, PubMed, EMbase, Web of Science and Medline, databases and the basic information, incidence density and risk factors were extracted. Results A total of 20 studies were included, comprising 5 from North America, 5 from Africa, 4 from Asia, 2 from Europe, and 4 from multicenter studies. The incidence density of hypertension in HIV-positive individuals ranged from 26.0 to 320.1 per 1 000 person-years. The risk factors of incident hypertension in HIV-positive individuals include traditional risk factors such as age, gender, race, BMI and abdominal obesity, diabetes, kidney disease, dyslipidemia, etc. HIV-specific factors included time of HIV infection, duration of antiviral therapy (ART), and antiviral drugs. Conclusions The incidence density of hypertension is relatively high among HIV-positive individuals, and the geographical variations are particularly pronounced. The contribution of traditional risk factors to incident hypertension among HIV-positive individuals is well established, underscoring the importance of implementing comprehensive strategies and interventions for primary prevention within this population's lifetstyles. However, the role of HIV and ART-related risk factors in hypertension remains unclear, and prospective studies are needed to better elucidate the epidemiology of hypertension in HIV-positive individuals.
- Human immunodeficiency virus positive /
- Hypertension /
- Incidence density

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图 1 文献筛选流程及结果

Figure 1. Flow diagram of the literature selection

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表 1 HIV阳性者高血压发病密度及影响因素

Table 1. Incidence density and risk factors of hypertension among HIV/AIDS individuals

地区 District	发表时间 Year	研究类型 Type			新发高血压诊断标准 Diagnostic criteria			随访时间 Follow-up time	研究地点 Research site
北美洲 North America	2013^[11]	队列研究 Cohort study			基线血压正常，随访2次测量≥140/90 mmHg或有高血压诊断史或诊断史且服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg or a history of hypertension diagnosis or a diagnosis history and taking antihypertensive medication			2001—2006	美国 United States
	2013^[21]	队列研究 Cohort study			基线血压正常，随访接受任何高血压治疗 Baseline blood pressure within normal range, with follow-up receiving any hypertension treatment			1998—2011	美国 United States
	2016^[13]	队列研究 Cohort study			基线血压正常，随访高血压诊断史 Baseline blood pressure within normal range, with follow-up history of hypertension diagnosis			1996—2013	美国 United States
	2018^[29]	队列研究 Cohort study			基线血压正常，随访2次测量≥140/90 mmHg或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on two occasions or taking antihypertensive medication			2005—2009	海地 Haiti
	2022^[40]	队列研究 Cohort study			基线血压正常，随访3次测量≥140/90 mmHg或有高血压诊断史 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on three occasions or a history of hypertension diagnosis			2014—2019	美国 United States
非洲Africa	2020^[10]	前瞻性研究Prospective study			基线血压正常，随访2次测量≥140/90 mmHg Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg			1年Year	加纳 Ghana
	2015^[14]	纵向研究Longitudinal study			基线血压正常，随访2次测量≥140/90 mmHg或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on two occasions or taking antihypertensive medication			2010—2013	乌干达 Uganda
	2016^[36]	队列研究 Cohort study			基线血压正常，随访3次测量≥140/90 mmHg或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on three occasions or taking antihypertensive medication			2005—2015	乌干达 Uganda
	2017^[18]	纵向研究Longitudinal study			基线血压正常，随访2次测量≥140/90 mmHg Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on two occasions			2013—2015	撒哈拉 Sahara
	2018^[28]	队列研究 Cohort study			基线血压正常，随访3次测量≥140/90 mmHg或一次测量≥180/110 mmHg或ART 3个月后有高血压诊断史或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on three occasions, or a single measurement ≥180/110 mmHg, or a history of hypertension diagnosis after 3 months of antiviral treatment, or taking antihypertensive medication			2004—2016	南非 South Africa
欧洲Europe	2012^[23]	队列研究 Cohort study			基线血压正常，随访2次测量≥140/90 mmHg或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on two occasions or taking antihypertensive medication			2007—2010	挪威 Norway
	2017^[16]	队列研究 Cohort study			基线血压正常，随访2次测量≥140/90 mmHg或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg on two occasions or taking antihypertensive medication			2010—2017	意大利 Italy
亚洲Asia	2021^[37]	前瞻性研究Prospective study			基线血压正常，随访2次测量≥130/80 mmHg Baseline blood pressure within normal range, with follow-up measurements ≥130/80 mmHg on two occasions			2019—2020	埃塞俄比亚 Ethiopia
	2020^[20]	队列研究 Cohort study			基线血压正常，随访≥140/90 mmHg或高血压诊断史 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg or a history of hypertension diagnosis			2017—2019	中国 China
	2018^[38]	队列研究 Cohort study			基线血压正常，随访≥140/90 mmHg或服用降压药 Baseline blood pressure within normal range, with follow-up measurements ≥140/90 mmHg or taking antihypertensive medication			2008—2016	韩国 Korea
	2020^[39]	纵向研究Longitudinal study			基线血压正常，随访≥140/90 mmHg或服用降压药 Baseline blood pressure is normal, with follow-up measurements ≥140/90 mmHg or taking antihypertensive medication			2008—2015	中国 China
多中心 Multicenter	2005^[25]	队列研究 Cohort study			基线血压正常，随访≥140/90 mmHg或服用降压药 Baseline blood pressure is normal, with follow-up measurements ≥140/90 mmHg or taking antihypertensive medication			1999—2003	多中心 Multicenter
	2017^[9]	队列研究 Cohort study			基线血压正常，随访高血压诊断史并服用降压药 Baseline blood pressure within normal range, with follow-up history of hypertension diagnosis and taking antihypertensive medication			2000—2013	多中心 Multicenter
	2018^[26]	队列研究 Cohort study			基线血压正常，随访≥140/90 mmHg或服用降压药 Baseline blood pressure is normal, with follow-up measurements ≥140/90 mmHg or taking antihypertensive medication			1999—2013	多中心 Multicenter
	2022^[41]	回顾性队列 Retrospective cohort study			基线血压正常，随访2次测量≥140/90 mmHg或服用降压药 Baseline blood pressure is normal, with follow-up measurements ≥140/90 mmHg on two occasions or taking antihypertensive medication			2012—2019	多中心 Multicenter

地区 District	年龄/岁 Age/years	男性占比/% Proportion of male/%	样本量 Sample size		治疗率 ART/%	发病密度/1 000人年 Incidence density/1 000 person-years		影响因素 Influenceing factors	NOS评分 NOS score
地区 District	年龄/岁 Age/years	男性占比/% Proportion of male/%	HIV阳性 HIV+	HIV阴性 HIV-	治疗率 ART/%	HIV阳性 HIV+	HIV阴性 HIV-	影响因素 Influenceing factors	NOS评分 NOS score
北美洲 North America	—	49.9	384	275	73.0	未治疗/治疗女性：160.0/90.0 男性：220.0/170.0 Untreated/treated Female: 160.0/90.0 Male: 220.0/170.0	女性：140.0男性：170.0 Female: 140.0 Male: 170.0		6
	43.0	80.0	2 390		84.0	64.1		年龄增加↑、黑人种族↑、体重升高↑、糖尿病↑ Age increase↑, Black ethnicity↑, weight gain↑, diabetes↑	5
	35.0	72.0	3 141		90.0	34.4		年龄增加↑、BMI≥30 kg/m²↑、糖尿病↑、最大肌酐≥1.4 mg/dL↑、可卡因↑、烟草↓、西班牙裔美国人↓ Age increase↑, BMI ≥ 30 kg/m²↑, diabetes↑, maximum creatinine≥ 1.4 mg/dL ↑, cocaine use↑, tobacco use↓, Hispanic Americans↓	6
	39.0	42.0	816		100.0	34.1		年龄增加↑、BMI高↑、IL-6升高↑ Age increase↑, high BMI↑, elevated IL-6↑	6
	47.0	71.5	2 274		—	63.0			4
非洲Africa	—	25.0	443		100.0	320.1		年龄增加↓、病载量对数↑、泰诺福韦↑ Age decrease↓, logarithm of viral load increase↑, Tenofovir↑	5
	32.0	33.0	3 389		100.0	111.5		年龄增加↑、男性↑、BMI≥30 kg/m²↑、最小CD4⁺ T细胞计数＜100个/μL↑ Age increase↑, male↑, BMI ≥ 30 kg/m²↑, minimum CD4⁺ T cell count＜100 cells/μL↑	6
	34.0	30.0	230		100.0	31.7		年龄增加↑、男性↑、BMI≥25 kg/m²↑、最小CD4⁺ T细胞计数＜100个/μL↑、ART后6个月D-二聚体水平↓ Age increase ↑, male ↑, BMI ≥25 kg/m²↑, minimum CD4 ⁺ T cell count＜100 cells/μL↑, decreased D-dimer levels after 6 months of ART↓	6
	38.2	38.4	834		75.5	120.0		年龄增加↑、BMI高↑、eGFR＜60 /ml(min·1.73 m²)↑ Age increase↑, high BMI↑, eGFR＜60 /ml(min·1.73 m²)↑	6
	37.0	60.8	60 570		100.0	54.4		年龄增加↑、男性↑、BMI增加↑、基线正常高值血压↑、CD4⁺ T细胞计数＜50个/μL↑、奈韦拉平↑、齐多夫定↑、司他夫定↑ Age increase↑, male↑, BMI increase↑, baseline hypertension with high values↑, CD4⁺ T cell count＜50 cells/μL↑, Nelfinavir ↑, Zidovudine↑, Sustiva↑	4
欧洲Europe	43.0	72.1	434		75.8	29.8		HIV感染时间↑、ART时长↑、尿白蛋白排泄异常↑ Increased duration of HIV infection↑, prolonged ART duration↑, increased abnormal urinary albumin excretion↑	5
	46.4	70.9	961		93.9	50.1		年龄增加↑、BMI增加↑、估算的心血管风险↑、基线血压高↑、HIV临床分期重↑ Age increase↑, BMI increase↑, elevated estimated cardiovascular risk↑, high baseline blood pressure↑, advanced HIV clinical stage increase↑	5
亚洲Asia	35.0	48.7	302		100.0	196.2		男性↑, 年龄增加↑, BMI较高↑, 糖尿病↑, AZT用药史↑ Increased male gender↑, age increase↑, higher BMI↑, elevated diabetes↑, history of AZT medication use↑	4
	52.7	76.9	229		—	90.3		普通型肥胖↑、腹部肥胖↑ Increased general obesity↑, abdominal obesity↑	5
	—	92.7	6 493		100.0	40.0		年龄增加↑、男性↑、ART依从性低↑、预防性抗生素(阿巴卡韦)↑ Age increase↑, male gender increase↑, low ART adherence↑, increased use of prophylactic antibiotic (Abacavir)↑	5
	35.2	75.2	984		100.0	76.0		BMI高↑、基线CD4⁺ T细胞计数高↑、最近病毒载量增加↑; 齐多夫定/泰诺福韦(相比司他夫定)↓, 最近CD4⁺/CD8+比值↓ High BMI↑, high baseline CD4⁺ T cell count↑, recent viral load increase↑; Zidovudine/Tenofovir (compared to Sustiva) decrease↓; recent CD4+/CD8+ ratio decrease↓	6
多中心 Multicenter	—	72.6	8 984		—	72.1		年龄增加↑、男性↑、BMI高↑、基线血压高↑、总胆固醇高↑、临床脂肪代谢障碍↑ Age increase↑, male↑, high BMI↑, high baseline blood pressure↑, high total cholesterol↑, increased clinical lipid metabolism disorders↑	6
	—	—	68 405		—	26.0		黑人种族↑ Black ethnicity↑	5
	38.0	72.2	33 278		68.4	34.2		年龄增加↑、男性↑、黑人种族↑、BMI高↑、糖尿病↑、血脂异常↑、eGFR低↑、CD4⁺ T细胞计数低↑、奈韦拉平↑ Indinavir/ritonavir↑ Age increase↑, male↑, Black ethnicity increase↑, high BMI↑, elevated diabetes↑, abnormal blood lipid levels↑, decreased eGFR↑, low CD4⁺ T cell count↑, increased use of Nelfinavir↑, increased use of Indinavir/Ritonavir↑	4
	43.0	73.4	4 606		54.0	126.2		基于INSTI/PI的治疗方案↑、基线CD4⁺ T细胞计数＜350个/μL↑、基线未治疗↑、BMI≥30 kg/m²↑ Tment regimen based on INSTI/PI↑, baseline CD4⁺ T cell count＜350 cells/μL↑, treatment-naive at baseline↑, BMI ≥ 30 kg/m²↑	5
注：1. ↑与新发高血压呈统计学正相关；↓与新发高血压呈统计学负相关。 2. ART，抗病毒治疗；NOS, 纽卡斯尔—渥太华量表；eGFR，肾小球滤过率估算值；AZT，齐多夫定；Indinavir/Ritonavir，茚地那韦/利托那韦；INSTI/PI, 整合酶链转移抑制剂/蛋白酶抑制剂。 3. “—”表示未提取到相关数。 Note: 1. ↑ indicates a positive correlation with incident hypertension; ↓ indicates a negative correlation with incident hypertension. 2. ART, antiretroviral therapy; NOS, Newcastle-Ottawa scale; eGFR，estimated glomerular filtration rate；AZT, zidovudine; Indinavir/ritonavir, Indinavir/ritonavir; INSTI/PI, integrase strand transfer inhibitor/protease inhibitor. 3. "—" indicates that no relevant data has been extracted.

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