Hypertension and Metabolic Syndrome in Persons with HIV
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HYPERTENSION AND METABOLIC SYNDROME (J SPERATI, SECTION EDITOR)
Hypertension and Metabolic Syndrome in Persons with HIV Sepiso K. Masenga 1,2 & Fernando Elijovich 3 & John R. Koethe 3 & Benson M. Hamooya 1,4 & Douglas C. Heimburger 3,5 & Sody M. Munsaka 2 & Cheryl L. Laffer 3 & Annet Kirabo 3,6
# The Author(s) 2020
Abstract Purpose of Review With the advent of highly active antiretroviral therapy (ART), the life span of persons with HIV (PWH) has been nearly normalized. With aging, prevalence of the metabolic syndrome (MetS), including hypertension, has increased in the HIV population and exceeds that in the general population in some studies. This is due to a combination of traditional risk factors in addition to the effects attributable to the virus and ART. We review recent findings on the mechanisms contributing to MetS and hypertension in PWH, particularly those specific to the viral infection and to ART. Recent Findings Activation of the renin-angiotensin-aldosterone system (RAAS) and chronic immune activation contribute to the development of MetS and hypertension in PWH. HIV proteins and some ART agents alter adipocyte health contributing to dyslipidemias, weight gain, and insulin resistance. HIV infection also contributes to hypertension by direct effects on the RAAS that intertwine with inflammation by the RAAS also contributing to T cell activation. Summary Recent data suggest that in addition to current ART, therapeutic targeting of the MetS and hypertension in PWH, by interfering with the RAAS, treating insulin resistance directly or by use of immunomodulators that dampen inflammation, may be critical for preventing or treating these risk factors and to improve overall cardiovascular complications in the HIV-infected aging population. Keywords HIV . Metabolic syndrome . Hypertension . Antiretroviral therapy . Immune modulators
Introduction HIV affects about 1.2 million persons in the USA [1]. The introduction of antiretroviral therapy (ART) has tremendously improved survival among persons with HIV (PWH), This article is part of the Topical Collection on Hypertension and Metabolic Syndrome Provided * Annet Kirabo [email protected] 1
HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
2
Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
3
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
4
School of Public Health, University of Zambia, Lusaka, Zambia
5
Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
6
Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Room 536 Robinson Research Building, Nashville, TN 37232-6602, USA
providing a nearly normal life span. However, aging PWH have a heightened risk for metabolic disorders, including diabetes mellitus and dyslipidemia. Because knowledge on the pathogenesis of metabolic disorders was acquired in HIVnegative populations, it i
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