{
  "abstract": "Background: People with HIV (PWH) face a growing burden of cardiovascular disease. Integrase strand transfer inhibitors (INSTIs) have been linked to weight gain and possibly hypertension, but head-to-head data among contemporary regimens are scarce, and few studies analyze older and modern regimens together. We evaluated the incidence of hypertension in antiretroviral therapy (ART)-naive PWH initiating Spanish guidelines-recommended first-line regimens since 2009.\n\nMethods: This study evaluated a retrospective cohort of ART-naive adults initiating first-line regimens from 2009 to 2024, grouped into non-nucleoside reverse transcriptase inhibitor (NNRTI), INSTI, and boosted protease inhibitor (PI)-based classes. Incident hypertension was defined by a composite of clinical diagnosis, antihypertensive initiation, or 2 consecutive measurements ≥ 140/90 mmHg. Time to hypertension was analyzed using Kaplan–Meir methods and Cox regression, with a prespecified INSTI subanalysis.\n\nResults: Among 1134 participants (median age 34.1 years; 89.8% male), 205 (18.1%) developed hypertension over a median of 135.9 weeks (incidence 4.9/100 person-years). Hypertension-free survival differed by class (log-rank P = .005); INSTI-based ART was independently associated with higher risk than NNRTIs (adjusted HR 1.61; 95% CI 1.20–2.17). Within the INSTI subgroup (n = 437; incidence 7/100 person-years), 5-year cumulative hypertension ranged from 9% (EVG/c/FTC/TAF) to 37% (dolutegravir-based); dolutegravir-based regimens carried a >2-fold adjusted hazard versus EVG/c/FTC/TAF. Higher body mass index was independently predictive but did not abolish this signal.\n\nConclusions: In ART-naive PWH, INSTI-based regimens were associated with a higher incidence of hypertension than NNRTI-based regimens, whereas the comparison with PI-based regimens was not statistically significant. Dolutegravir-containing regimens were independently associated with incident hypertension supporting systematic blood pressure surveillance and further comparative studies.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "name": "José I Bernardino",
      "orcid": "0000-0003-3501-8529"
    },
    {
      "name": "C Busca",
      "orcid": "0000-0002-4549-7749"
    },
    {
      "name": "L Serrano"
    },
    {
      "name": "A de Gea-Grela",
      "orcid": "0000-0001-9316-8766"
    },
    {
      "name": "M M Arcos-Rueda",
      "orcid": "0000-0002-9961-5544"
    },
    {
      "name": "L Martin-Carbonero",
      "orcid": "0000-0001-8102-4079"
    },
    {
      "name": "M L Montes"
    },
    {
      "name": "R Montejano",
      "orcid": "0000-0002-3446-0545"
    },
    {
      "name": "J Llenas-García",
      "orcid": "0000-0001-9125-7706"
    },
    {
      "name": "R Mican",
      "orcid": "0000-0002-6626-4266"
    },
    {
      "name": "R de Miguel",
      "orcid": "0000-0003-2749-818X"
    },
    {
      "name": "J González-García"
    },
    {
      "name": "A Borobia"
    },
    {
      "name": "José R Arribas"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5hevrynynzz53.bib",
  "cited_by": 0,
  "doi": "10.1093/ofid/ofag686",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13736122/",
  "id": "5hevrynynzz53",
  "issns": [
    "2328-8957"
  ],
  "landing_url": "https://doi.org/10.1093/ofid/ofag686",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00290"
    ],
    [
      "heading",
      "Epidemiology and Disease Surveillance"
    ],
    [
      "heading",
      "Major Article"
    ],
    [
      "openalex",
      "2725|HIV-related health complications and treatments"
    ]
  ],
  "openalex": "W7223473185",
  "pdf_url": "https://academic.oup.com/ofid/advance-article-pdf/doi/10.1093/ofid/ofag686/72482212/ofag686.pdf",
  "pmcid": "PMC13736122",
  "pmid": "42991121",
  "published": "2026-10-24",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/5hevrynynzz53.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:39Z",
      "native_id": "PMC13736122",
      "source": "pmc",
      "url": "https://doi.org/10.1093/ofid/ofag686"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|HIV-related health complications and treatments",
      "subfield": "infectious-disease"
    }
  ],
  "title": "First-Line Antiretroviral Regimens and Risk of Incident Hypertension in People With HIV: A 15-Year Cohort Study",
  "title_text": "First-Line Antiretroviral Regimens and Risk of Incident Hypertension in People With HIV: A 15-Year Cohort Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:39Z",
  "url": "https://research.draconitic.com/paper/5hevrynynzz53",
  "venue": "Open Forum Infectious Diseases",
  "versions": []
}