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Strokes in HIV+
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CROI: Types of ischemic strokes among HIV-infected individuals across the United States - (06/07/17)
Among 23,189 PLWH, 339 had a stroke....41% of ischemic strokes occurred in the setting of illicit drug use or CNS infection....Stroke rates are higher among persons living with HIV (PLWH)...
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STROKE in HIV+ Women do women have greater risk than
men?-http://www.natap.org/2016/CROI/croi_45.htm-increased trend for stroke in HIV+ women vs men....higher incidence in non Hispanic Blacks....hypertension & elevated LDL associated with 2.5 greater risk....UNSUPRESSED viral load associated with greatest risk (3 fold).....Stroke/TIA incidence was higher in women (2.88 vs. 1.40/1000 person-years in men) and in non-Hispanic blacks....After adjustment, female gender had a RR of 1.6 but was no longer significant
STROKE IN HIV+[ http://www.natap.org/2016/CROI/croi_92.htm]-uncontrolled viral load and low CD4 are also important factors. ART appears to be protective. The excess of strokes in younger HIV-infected women seen in some but not all of these reports is alarming and not adequately explained.....Admissions for AID-related opportunistic illnesses declined from 41% to 6%, while chronic conditions causing organ system dysfunction rose from 4% to 17%. Special sessions at this year's CROI focused on several important comorbid illnesses complicating HIV..... Atherosclerotic arterial diseases are increased in patients with HIV infection because of a high prevalence of traditional risk factors such as smoking, diabetes, hypertension, chronic kidney disease and chronic systemic and vascular inflammation. Coronary artery disease in HIV has been studied extensively, but stroke, which also causes major morbidity and mortality, is less well studied.....Chow: ....."In multivariable Poisson regression analysis using time-varying covariates, HIV RNA >200, hypertension, LDL >160, age (per 10 year increase) and renal dysfunction were associated with elevated relative risk (RR) (3.1, 2.8, 2.5, 2.1, 1.9, respectively). The risk associated with unsuppressed viral load was equivalent to 15 years of aging."
[from Jules: What is an ischemic stroke? Ischaemic strokes are the most common type of stroke. They occur when a blood clot blocks the flow of blood and oxygen to the brain. These blood clots typically form in areas where the arteries have been narrowed or blocked over time by fatty deposits known as plaques. This process is known as atherosclerosis......http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp#.V9qBjoVKJek
The CNICS team concluded that ischemic strokes predominate in people with HIV....Ischemic strokes related to illicit-drug use or infection represent a unique category of strokes, make up a substantial proportion of ischemic strokes (38%), and differed in both traditional and HIV-related risk factors.....http://www.natap.org/2016/AdverseReactComor/AdverseReactComor_12.htm
The researchers believe the association of ischemic risk factors with both traditional and CD4-count risk factors "suggests the importance of earlier ART, aggressive management of modifiable traditional risk factors, and targeted management of substance abuse in order to maximally reduce stroke risk" in people with HIV infection.
STROKE HIGHER in HIV/HCV Coinfected -http://www.natap.org/2016/CROI/croi_229.htm
STROKE/HIV in Africa http://www.natap.org/2016/HIV/NeurologyBehrouz-316-7.pdf.....HIV infection was the pre-
dominant risk factor for stroke in individuals aged>45 years
STROKE IN HIV+ Vets -Compared with uninfected veterans, HIV-infected veterans with a CD4+ T-cell count <200 cells/mm3 (HR = 1.66, 95% CI 1.30-2.12) or HIV-1 RNA ≥500 copies/mL (HR = 1.36, 95% CI 1.15-1.63) were at highest risk of incident ischemic stroke......Mean (SD) age at stroke event was 57.2 (9.8) and 58.4 (9.3) years" http://www.natap.org/2015/HIV/051215_01.htm
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