Patho-immune Mechanisms of Hypertension in HIV: a Systematic and Thematic Review

Abstract

Purpose of review: To systematically review recent findings on the role of immune cell activation in the pathogenesis of hypertension in people living with HIV (PLWH) and compare studies from Sub-Saharan Africa with what is reported in the USA and European literature according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Recent findings: PLWH have an increased risk for development of hypertension and cardiovascular disease. Chronic immune activation contributes to hypertension but the inflammatory milieu that predisposes PLWH to hypertension is poorly understood. We identified 45 relevant studies from 13 unique African countries. The prevalence of hypertension in PLWH on antiretroviral therapy (ART) and the ART-naive PLWH ranged from 6 to 50% and 2 to 41%, respectively. Interleukin (IL)-17A, interferon (IFN)-γ, and higher CD4⁺ T cell counts were associated with hypertension in ART-treated participants. Targeting adaptive immune activation could provide improved care for hypertensive PLWH. Further research is needed to characterize the inflammatory milieu contributing to hypertension in PLWH especially in African populations where the global burden of HIV is the highest.

Keywords: HIV; Hypertension; Inflammation; Patho-immune mechanisms.

Fig. 1

Conceptual schematic of the effect of HIV infection and treatment can activate the immune system leading to hypertension. Viral proteins and/or antiretroviral therapy (ART) activates antigen presenting and T cells which infiltrate the vasculature and the kidneys and release cytokines IL-6, IL-17A, and IFN-γ which promote vascular dysfunction, retention of sodium, and water, leading to hypertension