Increasing incidence of ischemic stroke in patients with HIV infection

Ovbiagele, Bruce; Nath, Avindra

doi:10.1212/wnl.0b013e31820a0cfc

Cited by 140 publications

(113 citation statements)

References 14 publications

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“…Conversely, in the United States, data from the Nationwide Inpatient Sample indicate that the proportion of all ischemic strokes attributable to HIV-infected individuals rose in the United States from 1997 to 2006, whereas the proportion of ICH hospitalizations in HIV-infected individuals was stable to decreased. 28 Our results support a study that observed a higher rate of a composite outcome of ICH and subarachnoid hemorrhage (SAH) in a Canadian HIV cohort compared with population-based controls. 29 Our study advances the existing literature by focusing specifically on ICH as opposed to a composite outcome of ICH and SAH, an important distinction given differences in underlying pathophysiology and etiology, and by including HIV-related clinical factors.…”

supporting

confidence: 89%

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Chow

Bacchetti

et al. 2014

Neurology

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Objective: To compare rates of intracerebral hemorrhage (ICH) in HIV-infected and uninfected individuals in a large clinical care cohort and to assess risk factors associated with ICH. Methods:We identified incident ICH in HIV-infected and uninfected control cohorts from the Partners Health Care system using ICD-9-CM codes. We constructed Cox proportional hazards models to estimate adjusted hazard ratios for HIV infection and other predictors of ICH.Results: The incidence rate of ICH was 2.29 per 1,000 person-years in HIV-infected individuals compared with 1.23 per 1,000 person-years in uninfected individuals, with an unadjusted incidence rate ratio of 1.85 (95% confidence interval 1.37-2.47, p , 0.001). In a multivariable model, HIV infection was independently associated with a higher hazard of ICH, although its effect diminished with increasing age. Female sex was associated with a lower hazard of ICH in the uninfected cohort but not in the HIV cohort. CD4 count ,200 3 10 6 cells/L and anticoagulant use were predictive of ICH.Conclusions: HIV infection conferred an increased adjusted hazard of ICH, which was more pronounced in young patients and in women. Cardiovascular and cerebrovascular event rates are increased in HIV infection. [1][2][3][4][5][6][7] Several studies pointing to an elevated risk of cerebrovascular disease in HIV-infected individuals have focused on ischemic stroke and excluded intracranial hemorrhage. 5,8,9 Whereas ischemic stroke and cardiovascular disease often coexist and share a similar risk profile and underlying mechanism, the association between HIV and intracerebral hemorrhage (ICH), which has mechanisms distinct from ischemic stroke, is less clear. We examined the association of HIV with the risk of ICH by comparing the incidence of ICH in HIV-infected and uninfected individuals in a large US clinical care cohort. Our primary hypothesis was that the rate of ICH in HIV-infected individuals would be higher than in uninfected individuals. We further controlled for potential confounders and identified predictors of ICH in HIV-infected individuals.METHODS Study design and patient population. We conducted an observational study of an HIV cohort derived from the Partners HealthCare System Research Patient Data Registry (RPDR), a clinical care database of all inpatient and outpatient encounters from Massachusetts General Hospital and Brigham and Women's Hospital. Other vascular outcomes have been studied in this cohort.3,5 HIV-infected individuals were identified from the RPDR using ICD-9-CM codes 042 or V08, previously validated in the cohort. 5 The HIV cohort was matched by age, race, and sex in a 1:10 ratio to HIV-uninfected individuals, who constituted the control cohort. The control cohort was intentionally overpopulated to allow for the possibility of missing data and application of the exclusion criteria. Within the cohorts, individuals who were at least 18 years of age at the beginning of the observation period and who had at least 1 inpatient or 2 outpatient clinical encou...

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supporting

confidence: 89%

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Chow

Bacchetti

et al. 2014

Neurology

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“…In line with previous reports, stroke patients with HIV were younger and a higher proportion were male, compared to those without HIV infection [2,6,9,10]. Traditional stroke risk factors were more prevalent in the non-HIV group, whilst anaemia was more prevalent in the HIV group [11].…”

Section: Discussionsupporting

confidence: 90%

“…Co-existence of HIV and stroke has increased and associations between HIV and stroke have been increasingly recognised [2,3].…”

Section: Introductionmentioning

confidence: 99%

Impact of HIV on inpatient mortality and complications in stroke in Thailand: a National Database Study

et al. 2017

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“…Ovbiagele and Nath reported a median age for individuals who had stroke with HIV infection of 42.9 years in 1997 and 48.4 years in 2006 in their review of database. Ortiz and colleagues reported a median age of 42 years between 1996 and 2004 in a similar setting [2,5].…”

Section: Discussionmentioning

confidence: 98%

Acute Ischemic Stroke in Young Immunocompromised Patient With Hypolipidemia

Devulapalli

2013

J Med Cases

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Although majority of strokes occur at age over 65, nearly onefourth of strokes occur in people under age of 65. In 30% of these patients, the cause of stroke remains undetermined and therefore there is a need for discovering rare risk factors like human immunodeficiency virus (HIV). The incidence of stroke in young adults lacks the traditional risk factors such as hypertension and diabetes, but HIV-infected patients can manifest with stroke at younger age. Pathogenesis of ischemic stroke in HIV infection is unclear but is postulated to be caused by several possible mechanisms, including opportunistic infection, vasculopathy, cardioembolism, coagulopathy and combination antiretroviral therapies, and so on. Secondary hypolipidemia is common in the setting of chronic infection like HIV and anemia. Low serum cholesterol is a known cause for intracerebral hemorrhage. Hypolipidemia causing ischemic stroke is unknown. We report a unique case of ischemic stroke in young severely immunocompromised patient in the setting of hypolipidemia.

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Increasing incidence of ischemic stroke in patients with HIV infection

Abstract: Background: Large-scale epidemiologic data on stroke in HIV-infected persons are scarce, espe-

Cited by 140 publications

References 14 publications

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Impact of HIV on inpatient mortality and complications in stroke in Thailand: a National Database Study

Acute Ischemic Stroke in Young Immunocompromised Patient With Hypolipidemia

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