Inflammatory Cytokine Profiles In HIV/AIDS Patients With Hypertension Comorbidity At Kenyatta National Hospital Comprehensive Care Center

Abstract

Background. Hypertension is the leading risk factor of Cardiovascular complications in HIV/AIDS patients and poses a threat to their survival, quality of life and economic productivity. The high predisposition to developing hypertension is associated with complex pathology that is linked to HIV virus inflammation. Chronic inflammation is responsible for most of the pathophysiology and is maintained by resurgence of the immune mechanisms following viral suppression a resultant effect of antiretroviral therapy. Inflammation has been linked independently as a potential causative factor of hypertension and driver of the disease pathophysiology. Less than half of HIV/AIDS patients with hypertension are diagnosed and further few are on treatment and well controlled. Some patients are diagnosed late with asymptomatic hypertensive urgency with very high readings e. g (BP>180mmhg/>110mmhg). Efforts to combine HIV treatment with vascular disease risk assessment are urgently needed to address hypertensive co-morbidity in HIV-positive persons. Thus, there is need to identify potential markers of inflammation that could be used to diagnose increased risk of developing hypertension in this population for effective prevention and control of the disorder. Objective: To determine the risk indicators of hypertension and variation in selected plasma cytokines in hypertension comorbidity in HIV/AIDS patients Methods: A total of 297 adult patients were recruited using systematic sampling. This was a cross-sectional study and data collection was carried out using questionnaires and desktop review of medical records as well as flow cytometry assay for selected cytokines, (IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, IFN-y and TNF-α) in participants’ blood samples. The study was carried out between January 2015 to August 2016. Ethical approval was obtained from Joint University of Nairobi and Kenyatta National Hospital Ethics and Research Committee (UON-KNHERC). Informed consent was obtained from participants with assurance of confidentiality xv in handling of data. Data was analyzed using STATA TM version 22 to establish inferential statistical correlations between the independent and dependent variables. Statistical significance was set at 95% confidence interval with 0.05 α level of significance Results: Out of the total 297 participants, 89 (30%) were male, while 208 (70%) were female. The age of the participants ranged from 30 – 57 years (M = 42.97, SD = 6.21). An independent-sample t test revealed that the average age of males (M = 44.56, SD = 6.05) was higher than females (M = 42.29, SD = 6.16), t (295) = 2.922, p < .01. The prevalence of hypertension was 69(23.2%). A high CD4+ cell count level above 250 showed a positive association with BMI values and the same CD4+ cell count within the range of 200 and below presented a negative association with BMI indicating wasting syndrome. This study showed that gender may be a key factor that influences secretion patterns and levels of IL-17A in HIV/AIDS patients The relation between CD4 counts and creatinine was statistically significant, F (1, 270) = 6.684, R2 = .024, β = -0.155, n = 272, p < .01. Also, the positive association between CD4 counts and BMI using linear regression was statistically significant, F (1, 295) = 9.321, R2 = .031, β = 0.175, n = 297, p < .01. Regression between gender and IL-17A showed a positive association (rs(124) = 0.417, p < 0.001). From this study female participants were likely to register increased IL-17A expression than male counterparts. Regression between CD4+ cell counts, creatinine and IL-6 showed a mild, negative and statistically significant association(rs(124) = -0.268, 0.285; p < 0.05) respectively. Regression between IL-6 and IL-8 showed a strong, positive and statistically significant association (rs(124) = 0.917, p < 0.001). However, the association between alcohol, tobacco use and IL-8 among participants was moderate, (rs(124) = 0.360, p < 0.01). INF γ levels between hypertensive and non-hypertensive participants were different with the latter showing higher values, p=0.003.