Prolonged Exposure to Antiretroviral Therapy and Risk of Developing Hypertension Among HIV-Infected Clinic Attendees: A Pilot Study in Rural Eastern Cape Province, South Africa

Antiretroviral Therapy (ART) has significantly improved outcomes in individuals with Human Immunodeficiency Virus (HIV), yet its long-term cardiovascular effects, especially on hypertension risk, remain debated. This pilot study investigated hypertension risk factors in HIV-positive patients undergoing ART. Seventy HIV-infected adults without baseline hypertension were enrolled and followed. Hypertension was defined using the 2017 ACC/AHA guidelines. Data on demographic, anthropometric, metabolic, inflammatory, coagulation, and HIV-related variables were collected. Cox regression analysis identified independent predictors of hypertension. Participants had a median age of 37 years (SD ±10.96), with 84.3% being female. After a median ART exposure of 61.01 months (range: 2–164), 27 individuals (38.6%) developed elevated blood pressure. In multivariable Cox models adjusting for metabolic syndrome and BMI, age ≥35 years was associated with a 2.2-fold higher hypertension risk (Hazard Ratio [HR]: 2.2; 95% Confidence Interval [CI]: 1.04–4.55; p=0.04). Elevated triglycerides significantly increased risk, with a 7.9-fold higher likelihood of hypertension (HR: 7.9; 95% CI: 1.04–59.5; p=0.046). ART regimen type—whether initial or current—did not independently predict hypertension. In conclusion, hypertension is prevalent during ART. Traditional cardiovascular risk factors, notably age ≥35 years and hypertriglyceridemia, were key independent predictors, emphasizing the need for routine cardiovascular risk assessment in HIV management.