Study uses blood pressure to examine association between perinatal HIV exposure and resulting disease severity

HIV infection is often linked to increased cardiovascular disease risk in adults – but what does that look like in children and adolescents?

A recent study from Children’s National, led by Tammy Brady, MD, PhD, pediatric nephrologist, examined whether HIV disease infection or severity is associated with blood pressure (BP) in pediatric patients.

While youth living with HIV had lower measures of adiposity than youth exposed but uninfected, systolic BP was similar between groups. Additional analyses also revealed that HIV disease severity was not associated with systolic or diastolic BP.

The findings, published in the American Heart Association Journal, highlight the need for further research to better understand long-term cardiovascular disease risk in this population and to identify opportunities for early monitoring and prevention strategies for families.

The big picture

The study examined BP among youth with and without HIV using data from 703 participants enrolled in the Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study, including 477 youth with HIV and 226 without HIV. Researchers compared BP patterns over time and evaluated whether HIV status or disease severity was associated with differences in BP, using repeated measures analyses focused on BP index and abnormal BP.

Overall, systolic blood pressure was similar between groups. Among preadolescents, youth with HIV had slightly lower average diastolic BP compared to those without HIV. Initial analyses also suggested that youth with HIV had a slightly lower diastolic BP index and lower odds of abnormal BP. However, these differences were no longer significant after accounting for body mass index.

Overall, HIV disease severity was not associated with systolic or diastolic blood pressure. These findings suggest that HIV itself does not appear to drive higher BP risk in youth, and that other factors – such as body composition – may play a more important role.

“We expected, based on adult studies, to see a clear link between HIV and higher blood pressure, especially with more advanced disease. But that wasn’t the case,” Dr. Brady said. “What stood out instead was how much the usual risk factors – like excess weight – still matter.”

Why this matters

While cardiovascular health is often viewed through an adult lens, this research underscores the importance of earlier awareness, helping clinicians identify and support young, at-risk patients with lifestyle counseling before issues go undetected or progress.

The study also highlights important context for interpreting these findings. Youth with HIV differed demographically from their peers without HIV – they were more likely to be Black non-Hispanic, report higher household incomes and have lower measures of adiposity. These differences may help explain variations in blood pressure and reinforce the need to consider both social and clinical factors when assessing cardiovascular risk.

Prevention and management of traditional cardiovascular disease risk factors remain critical for youth living with HIV. These findings reinforce the need for comprehensive, individualized care approaches that address the full picture of a child’s health, not just their diagnosis.

“It’s a strong reminder that everyday heart healthy habits remain essential for protecting cardiovascular health of all children,” Dr. Brady said.

Read the full study, “Association of Perinatal HIV Exposure and Perinatally Acquired HIV Disease Severity with Blood Pressure Among Youth,” in the American Heart Association Journal.