Elevated Eosinophils as a Feature of Inflammation Associated With Hypertension in Virally Suppressed People Living With HIV

J Am Heart Assoc. 2020 Feb 18;9(4):e011450. doi: 10.1161/JAHA.118.011450. Epub 2020 Feb 17.


Background People living with HIV (PLWH) are at increased risk of cardiovascular disease, including hypertension, which persists despite effective plasma viral suppression on antiretroviral therapy. HIV infection is characterized by long-term alterations in immune function, but the contribution of immune factors to hypertension in PLWH is not fully understood. Prior studies have found that both innate and adaptive immune cell activation contributes to hypertension. Methods and Results We hypothesized that chronic inflammation may contribute to hypertension in PLWH. To test this hypothesis, we enrolled a cohort of 70 PLWH (44% hypertensive) on a long-term single antiretroviral therapy regimen for broad phenotyping of inflammation biomarkers. We found that hypertensive PLWH had higher levels of inflammatory cytokines, including tumor necrosis factor-α receptor 1, interleukin-6, interleukin-17, interleukin-5, intercellular adhesion molecule 1 and macrophage inflammatory protein-1α. After adjustment for age, sex, and fat mass index, the circulating eosinophils remained significantly associated with hypertension. On the basis of these results, we assessed the relationship of eosinophils and hypertension in 2 cohorts of 50 and 81 039 similar HIV-negative people; although eosinophil count was associated with prevalent hypertension, this relationship was abrogated by body mass index. Conclusions These findings may represent a unique linkage between immune status and cardiovascular physiological characteristics in HIV infection, which should be evaluated further.

Keywords: HIV; eosinophilia; hypertension; inflammation; interleukin‐5.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • Case-Control Studies
  • Chronic Disease
  • Cross-Sectional Studies
  • Cytokines / blood
  • Eosinophils / immunology*
  • Eosinophils / metabolism
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / immunology*
  • HIV Long-Term Survivors*
  • Humans
  • Hypertension / blood
  • Hypertension / epidemiology
  • Hypertension / immunology*
  • Immunity, Innate*
  • Inflammation / blood
  • Inflammation / epidemiology
  • Inflammation / immunology*
  • Inflammation Mediators / blood
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Sustained Virologic Response
  • Tennessee / epidemiology
  • Time Factors


  • Anti-Retroviral Agents
  • Cytokines
  • Inflammation Mediators