Primary aldosteronism with HIV infection: Important considerations when using the aldosterone:renin ratio to screen this unique population

Primary aldosteronism (PA) was initially thought to be a rare cause of hypertension. Currently, the screening modality for PA in patients with presumed secondary hypertension is the aldosterone: renin ratio (ARR). Since the advent of the ARR, the prevalence rates of PA have increased dramatically in the general population. Recently however, several reviews have suggested flaws in the ARR, leading to a possible overestimation of the prevalence of this disease. Within the HIV-positive population, there are few documented cases of PA however. With the increasing reliance on the ARR to screen and diagnose this disorder, this number is likely to rise. It is now known that the HIV has rennin-like properties. Therefore, HIV infection itself can inappropriately alter the ARR. Additionally, the medication used to treat HIV infection can also affect this value. Although the ARR is a convenient tool for screening patients with possible PA, there are multiple associated concerns particularly when it is applied to the HIV-positive population. Therefore, further testing is essential in all HIV-positive patients in whom PA is suspected.