 |
|
|
| |
Age at Stroke 15 Years Younger in HIV-Positives vs Negatives in New York City
|
| |
| |
XIX International AIDS Conference, July 22-27, 2012, Washington, DC
Mark Mascolini
HIV-positive people admitted to a stroke unit at a New York City hospital were an average 15 years younger than a comparison group of stroke patients without HIV [1]. Traditional stroke risk factors--such as hypertension, diabetes, and hyperlipidemia--did not differ between the two groups, but a higher proportion of the HIV group had ischemic stroke.
Prior research established that HIV contributes to a higher incidence of ischemic stroke in the United States (5.27 per 1000 person-years in HIV patients versus 3.75 per 1000 in HIV-negative patients) [2]. A nationwide 1997-2006 study of US patients with a primary discharge diagnosis of stroke found that the proportion of stroke patients with HIV rose from 0.09% in 1997 to 0.15% in 2006 (P < 0.0001) [3]. During that period the number of stroke hospitalizations with coexisting HIV rose 60% from 888 to 1425, whereas the overall number of US stroke hospitalizations fell 7%.
Researchers at New York's Beth Israel Medical Center conducted a case-control study to compare clinical and epidemiologic factors in stroke patients with and without HIV. This retrospective chart review involved 41 adults know to be HIV-positive and admitted to the stroke unit with acute stroke between January 2005 and June 2011 and 101 randomly selected HIV-negative patients admitted to the unit during the same period. All study participants had acute stroke confirmed by imaging.
Thirty-one of 38 HIV-positive people with a known antiretroviral treatment status (82%) were taking antiretrovirals when they had a stroke. Seventeen of these 31 (54%) were taking a protease inhibitor, 7 (22%) were taking a nonnucleoside, and 2 (6%) were taking an integrase inhibitor. Among people with a CD4 count available, counts averaged 321 and ranged from 8 to 1034.
The 41 people with HIV represented 2.4% of the 1679 total admissions during the study period. (For comparison, estimated HIV prevalence in New York City in 2010 was 1.4% [4]). The HIV stroke group included 30 men (73%) and 11 women, while the HIV-negative stroke group included 47 men (47%) and 54 women (P = 0.004).
Age in stroke patients with HIV averaged 57.2 years (range 41 to 80), compared with 72.4 (range 34 to 99) in the HIV-negative group (P = 0.001). The HIV-positive and negative groups differed significantly in racial composition (white 24.4% HIV and 74% non-HIV, black 32.4% HIV and 14% non-HIV, and Asian 0% HIV and 12% non-HIV, P = 0.001).
There was a higher proportion of never smokers in the HIV-negative group (88.1%) than in the HIV-positive group (36.5%), and a higher proportion of current smokers in the HIV group (36.9% versus 0.9%) (P = 0001).
On admission to the stroke unit, the HIV group had a significantly lower average score on the National Institutes of Health Stroke Scale [5] (5.19 versus 9.54, P = 0.02). A lower score indicates less severe stroke. A higher proportion of people with HIV had an ischemic stroke (95.1% versus 82.2%), and a lower proportion had intracranial hemorrhage (4.9% versus 17.8%) (P = 0.044). Two stroke patients with HIV (4.8%) died, compared with 11 (10.9%) without HIV, a nonsignificant difference.
Compared with the HIV-negative group, HIV-positive people had a significantly lower average systolic blood pressure (140 versus 154.5 mm Hg, P = 0.033). The HIV group had a significantly lower "good" high-density lipoprotein cholesterol than the HIV-negative group (40.8 versus 47.8 mg/dL, P = 0.04). However, proportions with hyperlipidemia or hypertension did not differ significantly between the two groups; neither did the proportion with diabetes.
When the Beth Israel investigators repeated the analysis with HIV-negative controls age-matched to HIV-positive people, results were largely similar. The researchers noted that the small sample size and retrospective nature of the study limit their analysis.
They proposed that the greater likelihood of ischemic stroke in HIV-positive people despite their much younger age and similar traditional risk factors supports the hypothesis that "HIV in some way promotes stroke."
In the nationwide stroke study, factors independently associated with higher odds of comorbid HIV in stroke patients were Medicaid, urban hospital admission, dementia, liver disease, renal disease, and cancer [3].
References
1. Nigo M, Walker A, Lucido D, Shah A, Skliut M, Mildvan D. Stroke in human immunodeficiency virus (HIV) infected patients. XIX International AIDS Conference. July 22-27, 2012. Washington, DC. Abstract THAB0204.
2. Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60:351-358.
3. Ovbiagele B, Nath A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology. 2011;76:444-450. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034413/?tool=pubmed.
4. HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene. New York City HIV/AIDS annual surveillance statistics 2010. http://www.nyc.gov/html/doh/downloads/pdf/ah/surveillance2010-tables-all.pdf.
5. National Institutes of Health. NIH Stroke Scale. http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale_Booklet.pdf.
|
| |
|
|
|
|
|
