Hypertension in the HIV-infected patient

Abstract

HIV infection has reached endemic proportions in many African countries. In addition, HIV infection is a significant cause of renal dysfunction in the United States. HIV patients are at higher risk of developing hypertension at a younger age than the general population. Predisposing factors for developing hypertension include vasculitis in small, medium, and large vessels in the form of leukocytoclastic vasculitis, and aneurysms of the large vessels such as the carotid, femoral, and abdominal aorta with impairment of flow to the renal arteries. A syndrome of acquired glucocorticoid resistance has been described in patients with HIV with hypercortisolism and a lower affinity of the glucocorticoid receptors. The syndrome is characterized clinically by weakness, hypertension or hypotension, and skin pigmentation changes. Acute and chronic renal failure is often associated with HIV infection. The associated dysfunction in water and salt handling often induces hypertension. Finally, atherosclerosis has been described in young adults with HIV infection secondary to receiving highly active antiretroviral therapy.

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References and Recommended Reading

  1. 1.

    Galette G, Morrow C: Noninfectious manifestations of human immunodeficiency virus infection. Emerg Med Clin North Am 1995, 13:105–131.

    Google Scholar 

  2. 2.

    Norbiato G, Galli M, Righini V, Moroni M: The syndrome of acquired glucocorticoid resistance in HIV infection. Clin Endocrinol Metab 1994, 8:777–787.

    CAS  Google Scholar 

  3. 3.

    Norbiato G, Bevilacqua M, Vago T, Clerici M: Glucocorticoid resistance and the immune function in the immunodeficiency syndrome. Ann NY Acad Sci 1998, 840:835–847. Suggested mechanisms of modification of the glucocorticoid receptors in HIV patients include altered production of interferon-a and other inflammatory cytokines by HIV-infected cells.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Mattana J, Siegal FP, Sandaran RT, Singhal PC: Absence of age-related increase in systolic blood pressure in ambulatory patients with HIV infection. Am J Med Sci 1999, 317:232–237. A characteristic of the blood pressure profile of patients with HIV infection is the absence of an age-related increase in systolic blood pressure.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Nichols WW, O‘Rourke MF: McDonald‘s Blood Flow in Arteries. Theoretical, Experimental and Clinical Principles, fourth edn. Edited by Arnold E. London, Sydney, Auckland: Oxford University Press; 1998.

    Google Scholar 

  6. 6.

    Safar ME: Pulse pressure in essential hypertension: clinical and therapeutical implications. J Hypertens 1989, 7:769–776.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Franklin SS, Gustin W IV, Wong ND, et al.: Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997, 96:308–315.

    PubMed  CAS  Google Scholar 

  8. 8.

    Valeri A, Neusy AJ: Acute and chronic renal disease in hospitalized patients. Clin Nephrol 1991, 35:110–118.

    PubMed  CAS  Google Scholar 

  9. 9.

    Brady HR, Brenner BM, Lieberthal W: Acute renal failure. In The Kidney, edn 6. Edited by Brenner BM. Philadelphia: WB Saunders; 2000:1201–1202.

    Google Scholar 

  10. 10.

    Kelleher P, Severn A, Tomson C, et al.: The haemolytic uraemic syndrome in patients with AIDS. Genitourin Med 1996, 72:172–175.

    PubMed  CAS  Google Scholar 

  11. 11.

    Turner ME, Kher K, Rakusan T, et al.: Atypical hemolytic uremic syndrome in human immunodeficiency virus-1 infected children. Pediatr Nephrol 1997, 11:161–163.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Winston J, Klotman PE: HIV-associated nephropathy. Mt Sinai J Med 1998, 65:237–232.

    Google Scholar 

  13. 13.

    Frankum BS, Savdie E: HIV and renal disease. Med J Aust 1996, 164:483.

    PubMed  CAS  Google Scholar 

  14. 14.

    US Renal Data System: USRDS 1995 annual data report. Bethesda, MD: The National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Diseases; 1995.

  15. 15.

    D‘Agati V, Suh JL, Carbone L, et al.: Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study. Kidney Int 1989, 35:1358–1370.

    PubMed  CAS  Google Scholar 

  16. 16.

    Wali RK, Drachenberg CI, Papadimitriou JC, et al.: HIV-associated nephropathy and response to highly-active antiretroviral therapy. Lancet 1998, 352:783–784.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Cantor ES, Kimmel PL, Bosch JP: Effect of race on expression of acquired immunodeficiency syndrome-associated nephropathy. Arch Intern Med 1991, 51:125–128.

    Article  Google Scholar 

  18. 18.

    Humphreys MH: Human immunodeficiency virus-associated nephropathy. East is east and west is west? Arch Intern Med 1990, 150:253–255.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Bruggeman LA, Quaggin S, Coffman T, Klotman PE: HIV-associated nephropathy in transgenic mice is due to renal transgene expression. J Am Soc Nephrol 1996, 7:1851.

    Google Scholar 

  20. 20.

    Poli A, Abramo F, Taccini E, et al.: Renal involvement in feline immunodeficiency virus infection: a clinicopathological study. Nephron 1993, 64:282–288.

    PubMed  CAS  Google Scholar 

  21. 21.

    Ray PE, Henry D, Xu L, et al.: Infection and injury of human renal tubular epithelial cells by HIV-1 derived from children with HIVAN. J Am Soc Nephrol 1996, 7:1341.

    Google Scholar 

  22. 22.

    Glassock RJ, Cohen AH, Danovitch G, Parsa KP: HIV infection and the kidney. Ann Intern Med 1990, 112:35–49.

    PubMed  CAS  Google Scholar 

  23. 23.

    Langs C, Gallo GR, Schacht RG, et al.: Rapid renal failure in AIDS focal glomerulosclerosis. Arch Intern Med 1990, 150:287–292.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Smith MC, Pawar R, Carey JT, et al.: Effect of corticosteroid therapy on human immunodeficiency virus associated nephropathy. Am J Med 1994, 97:145–151.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Cook PP, Appel RG: Prolonged clinical improvement in HIV-associated nephropathy with zidovudine therapy [letter]. J Am Soc Nephrol 1990, 1:842.

    PubMed  CAS  Google Scholar 

  26. 26.

    Lam M, Park MC: HIV-associated nephropathy: beneficial effect of zidovudine therapy [letter]. N Engl J Med 1990, 323:1775–1776.

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Michel C, Dosquet P, Ronoco P, et al.: Nephropathy associated with infection by human immunodeficiency virus: a report on eleven cases including six treated with zidovudine. Nephron 1992, 62:434–440.

    PubMed  CAS  Google Scholar 

  28. 28.

    Ifudu O, Rao TKS, Tan CC, et al.: Zidovudine is beneficial in human immunodeficiency virus associated nephropathy. Am J Nephrol 1995, 15:217–221.

    PubMed  CAS  Article  Google Scholar 

  29. 29.

    Burns GC, Matute R, Onyema D, et al.: Response to inhibition of angiotensin converting enzyme in human immunodeficiency virus associated nephropathy: a case report. Am J Kidney Dis 1994, 23:441–443.

    PubMed  CAS  Google Scholar 

  30. 30.

    Carbone L, D‘Agati V, Cheng JT, Appel GB: Course and prognosis of human immunodeficiency virus-associated nephropathy. Am J Med 1989, 87:389–395.

    PubMed  CAS  Article  Google Scholar 

  31. 31.

    Kimmel PL, Mishkin GJ, Umana WO: Captopril and renal survival in patients with human immunodeficiency virus nephropathy. Am J Kidney Dis 1996, 28:202–208.

    PubMed  CAS  Google Scholar 

  32. 32.

    Chetty R, Batitang S, Nair R: Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol 2000, 31:374–379.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Constans J, Marchand JM, Conri C, et al.: Asymptomatic atherosclerosis in HIV-positive patients: a case-control ultrasound study. Ann Med 1995, 27:683–685.

    PubMed  CAS  Google Scholar 

  34. 34.

    Paton P, Tabib A, Loire R, Tete R: Coronary artery lesions and human immunodeficiency virus infection. Res Virol 1993, 144:225–231.

    PubMed  CAS  Google Scholar 

  35. 35.

    Tabib A, Greenland T, Mercier I, et al.: Coronary lesions in young HIV-positive subjects at necropsy [letter]. Lancet 1992, 340:730.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Kestelyn P, Lepage P, Van de Perre P: Perivasculitis of retinal vessels as an important sign in children with AIDS-related complex. Am J Ophthalmol 1985, 100:614–615.

    PubMed  CAS  Google Scholar 

  37. 37.

    Henry K, Melroe H, Huebsch J, et al.: Severe premature coronary artery disease with protease inhibitors [letter]. Lancet 1998, 351:1328.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Behrens G, Schmidt H, Meyer D, et al.: Vascular complications associated with use of HIV protease inhibitors [letter]. Lancet 1998, 351:1958.

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Cattelan A, Trevenzoli M, Naso A, et al.: Severe hypertension and renal atrophy associated with indinavir. Clin Infect Dis 2000, 30:619–621. A report of a patient with HIV who developed severe hypertension and renal atrophy secondary to indinavir.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Hanabusa H, Tagami H, Hataya H: Renal atrophy associated with long-term treatment with indinavir. N Engl J Med 1999, 340:392–393.

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Khurana V, De la Fuente M, Bradley TP: Hypertensive crisis secondary to phenylpropanolamine interacting with triple-drug therapy for HIV prophylaxis. Am J Med 1999, 106:118–119.

    PubMed  Article  CAS  Google Scholar 

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Aoun, S., Ramos, E. Hypertension in the HIV-infected patient. Current Science Inc 2, 478–481 (2000). https://doi.org/10.1007/s11906-000-0031-1

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Keywords

  • Human Immunodeficiency Virus
  • Glucocorticoid Receptor
  • Angiotensin Converting Enzyme Inhibitor
  • Indinavir
  • Hemolytic Uremic Syndrome