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Antiretroviral Treatment and Antihypertensive Therapy
Nicolás R Robles1, Francesco Fici2, Julian Valladares1
1Servicio de Nefrologia, Hospital Universitario de Badajoz, Badajoz, Spain.
Insights
Hypertension is a significant concern for people with human immunodeficiency virus (HIV), especially those on antiretroviral therapy (ART). Managing blood pressure in HIV patients requires careful consideration of drug interactions and cardiovascular risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Hypertension is increasingly prevalent in individuals with human immunodeficiency virus (HIV), particularly those undergoing antiretroviral therapy (ART).
- The prevalence of high blood pressure is notably higher in HIV-infected populations compared to HIV-unnegative individuals.
- Managing cardiovascular risk is crucial for the holistic care of HIV-positive patients.
Purpose of the Study:
- To highlight the growing threat of hypertension in the HIV-positive population.
- To emphasize the importance of assessing cardiovascular risk in HIV patients.
- To discuss pharmacological interactions between antiretroviral (ARV) drugs and antihypertensive medications.
Main Methods:
- Review of current literature on hypertension in HIV.
- Analysis of potential drug-drug interactions between ARVs and antihypertensives.
- Evaluation of recommended antihypertensive treatment strategies for HIV patients.
Main Results:
- HIV patients exhibit a significantly higher prevalence of hypertension.
- Antiretroviral drugs (e.g., protease inhibitors, NNRTIs) can alter serum levels of antihypertensives.
- Certain antihypertensives (e.g., calcium channel blockers, diuretics) can affect ARV plasma concentrations.
Conclusions:
- Treatment of hypertension in HIV patients necessitates careful consideration of drug interactions.
- Angiotensin-converting enzyme (ACE) inhibitors or thiazide/thiazide-like diuretics are preferred antihypertensive agents for HIV patients.
- Individualized cardiovascular risk assessment is paramount when managing hypertension in the context of HIV infection.
Abstract:
The presence of hypertension among the population with human immunodeficiency virus (HIV) has become a new threat to the health and well-being of people living with this disease, in particular, among those who received antiretroviral therapy. The estimated prevalence of high blood pressure in HIV-infected patients is significantly higher than the rate observed in HIV-uninfected subjects. The approach to the HIV-positive patient requires the assessment of individual cardiovascular risk and its consideration when designing the individualized target. On the other hand, the numerous pharmacological interactions of antiretroviral (ARV) drugs are essential elements to take into account. Serum levels of any kind of antihypertensive drugs may be influenced by the coadministration of protease inhibitors, non-nucleoside reverse transcriptase inhibitor, or other antiretroviral. Similarly, plasma concentrations of antiretroviral drugs can be increased by the concomitant use of calcium channel blockers or diuretics. In this regard, the treatment of high blood pressure in HIV patients should be preferentially based on ACE inhibitors or thiazide/thiazide-like diuretics or their combination.
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