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Stroke in HIV-infected patients in the combination antiretroviral therapy era
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Reported by Jules Levin
CROI 2016 Feb 22-24 Boston
Juan Berenguer 1,2, Alejandro Alvaro-Meca 3, Asuncion Diaz 4, Dariela Micheloud 1,2, Salvador Resino 5
1Hospital General Universitario "Gregorio Maranon", Madrid, Spain. 2Instituto de Investigacion Sanitaria Gregorio Maranon (IiSGM), Madrid, Spain. 3Medicina Preventiva y Salud Publica, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain. 4Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain. 5Unidad de Infeccion Viral e Inmunidad, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
Program Abstract
Both HIV and HCV infections have been associated with increased risk of stroke. We estimated incidence and mortality rates of stroke (hemorrhagic or ischemic) in HIV-infected (HIV+) patients (Pts.) in the combination antiretroviral therapy (cART) era, with particular attention to HIV/HCV-coinfected (HIV/HCV) Pts.
We reviewed the computerized data from patients in the Spanish Minimum Basic Data Set (MBDS), that includes information from Pts. discharged in almost 300 hospitals. Pts. were identified according to the following ICD-9-CM codes: HIV infection (042 or V08) with or without HCV infection (070.44, 070.54, 070.7x, or V02.62) with hemorrhagic (h) stroke (430-432) or ischemic (i) stroke (433-437). HBV infection (070.2x, 070.3x, or V02.61) was an exclusion criterion. Pts. were classified as HIV-monoinfected (HIV-Mono) or HIV/HCV. We estimated rates (events per 10,000 patient-years) in the period 1999-2011; time interval that was broken down into three periods: 1st (1997-1999), 2nd (2000-2003) and 3rd (2004-2011). For the calculation or rates, the numerator was the number of events within each period. The denominator was the number of patient-years at risk within each period, for this purpose we estimated the number of HIV+, HIV/HCV, and HIV-Mono Pts. in each period.
h-stroke rates: In the 1st period rates of h-stroke were higher for HIV-Mono Pts. than for HIV/HCV Pts. From the 1st to the 2nd period, rates of h-stroke decreased in HIV-Mono Pts. (from 16.0 to 5.5; P<0.001) and increased in HIV/HCV Pts. (from 1.3 to 7.6; P <0.001). In the 3rd period, rates of h-stroke were higher for HIV/HCV Pts. than for HIV-Mono Pts. (Figure 1A). i-stroke rates: Similar trends were found for i-stroke. Rates decreased significantly from the 1st to the 3rd period in HIV-Mono Pts. (from 27.7 to 16.4; P <0.001), and increased significantly in HIV/HCV Pts. (from 1.8 to 12.6; P <0.001) (Figure 1B). Mortality rates: mortality rates for both h-stroke and i-stroke were higher for HIV-Mono Pts. than for HIV/HCV Pts. in the 1st period; however, this trend was reversed by the 3rd period (Figure 1C & 1D). The adjusted likelihood of death for h-stroke in the 3rd period was higher for HIV/HCV Pts. than for HIV-Mono Pts.
Conclusions: In the cART era, incidence and mortality rates of stroke decreased in HIV-Mono Pts. but increased steadily in HIV/HCV Pts.
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