HIV status and the risk of ischemic stroke among men

doi:10.1212/WNL.0000000000001560

. 2015 May 12;84(19):1933-40.

doi: 10.1212/WNL.0000000000001560. Epub 2015 Apr 10.

HIV status and the risk of ischemic stroke among men

Jason J Sico¹, Chung-Chou H Chang², Kaku So-Armah², Amy C Justice², Elaine Hylek², Melissa Skanderson², Kathleen McGinnis², Lewis H Kuller², Kevin L Kraemer², David Rimland², Matthew Bidwell Goetz², Adeel A Butt², Maria C Rodriguez-Barradas², Cynthia Gibert², David Leaf², Sheldon T Brown², Jeffrey Samet², Lewis Kazis², Kendall Bryant², Matthew S Freiberg²; Veterans Aging Cohort Study

Affiliations

¹ From the VA Connecticut Health Care System (J.J.S., A.C.J., M.S., K.M.), West Haven Veterans Administration Medical Center, West Haven; Yale University School of Medicine (J.J.S., K.S.-A., A.C.J.), New Haven, CT; University of Pittsburgh School of Medicine (C.-C.H.C., K.L.K., A.A.B.); University of Pittsburgh Graduate School of Public Health (C.-C.H.C., L.H.K.), Pittsburgh, PA; Boston Medical Center (E.H.), MA; Emory University School of Medicine and Atlanta Veterans Administration Medical Center (D.R.), Atlanta, GA; David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System (M.B.G., D.L.), Los Angeles, CA; VA Pittsburgh Health Care System (A.A.B.), Pittsburgh, PA; Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine (M.C.R.-B.), Houston, TX; Washington DC Veterans Administration Medical Center and George Washington University School of Medicine (C.G.), Washington, DC; James J. Peters VA (S.T.B.), Bronx; Mount Sinai School of Medicine (S.T.B.), New York, NY; Boston University School of Medicine (J.S.), MA; Center for the Assessment of Pharmaceutical Practices (L.K.), Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research (L.K.), a Center for Innovation, Veterans Administration Medical Center, Bedford, MA; National Institute on Alcohol Abuse and Alcoholism (K.B.), Bethesda, MD; and Vanderbilt University School of Medicine and the Nashville Veterans Affairs Medical Center (M.S.F.), Nashville, TN. jason.sico@va.gov.
² From the VA Connecticut Health Care System (J.J.S., A.C.J., M.S., K.M.), West Haven Veterans Administration Medical Center, West Haven; Yale University School of Medicine (J.J.S., K.S.-A., A.C.J.), New Haven, CT; University of Pittsburgh School of Medicine (C.-C.H.C., K.L.K., A.A.B.); University of Pittsburgh Graduate School of Public Health (C.-C.H.C., L.H.K.), Pittsburgh, PA; Boston Medical Center (E.H.), MA; Emory University School of Medicine and Atlanta Veterans Administration Medical Center (D.R.), Atlanta, GA; David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System (M.B.G., D.L.), Los Angeles, CA; VA Pittsburgh Health Care System (A.A.B.), Pittsburgh, PA; Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine (M.C.R.-B.), Houston, TX; Washington DC Veterans Administration Medical Center and George Washington University School of Medicine (C.G.), Washington, DC; James J. Peters VA (S.T.B.), Bronx; Mount Sinai School of Medicine (S.T.B.), New York, NY; Boston University School of Medicine (J.S.), MA; Center for the Assessment of Pharmaceutical Practices (L.K.), Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research (L.K.), a Center for Innovation, Veterans Administration Medical Center, Bedford, MA; National Institute on Alcohol Abuse and Alcoholism (K.B.), Bethesda, MD; and Vanderbilt University School of Medicine and the Nashville Veterans Affairs Medical Center (M.S.F.), Nashville, TN.

PMID: 25862803
PMCID: PMC4433456
DOI: 10.1212/WNL.0000000000001560

HIV status and the risk of ischemic stroke among men

Jason J Sico et al. Neurology. 2015.

. 2015 May 12;84(19):1933-40.

doi: 10.1212/WNL.0000000000001560. Epub 2015 Apr 10.

Authors

Affiliations

¹ From the VA Connecticut Health Care System (J.J.S., A.C.J., M.S., K.M.), West Haven Veterans Administration Medical Center, West Haven; Yale University School of Medicine (J.J.S., K.S.-A., A.C.J.), New Haven, CT; University of Pittsburgh School of Medicine (C.-C.H.C., K.L.K., A.A.B.); University of Pittsburgh Graduate School of Public Health (C.-C.H.C., L.H.K.), Pittsburgh, PA; Boston Medical Center (E.H.), MA; Emory University School of Medicine and Atlanta Veterans Administration Medical Center (D.R.), Atlanta, GA; David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System (M.B.G., D.L.), Los Angeles, CA; VA Pittsburgh Health Care System (A.A.B.), Pittsburgh, PA; Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine (M.C.R.-B.), Houston, TX; Washington DC Veterans Administration Medical Center and George Washington University School of Medicine (C.G.), Washington, DC; James J. Peters VA (S.T.B.), Bronx; Mount Sinai School of Medicine (S.T.B.), New York, NY; Boston University School of Medicine (J.S.), MA; Center for the Assessment of Pharmaceutical Practices (L.K.), Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research (L.K.), a Center for Innovation, Veterans Administration Medical Center, Bedford, MA; National Institute on Alcohol Abuse and Alcoholism (K.B.), Bethesda, MD; and Vanderbilt University School of Medicine and the Nashville Veterans Affairs Medical Center (M.S.F.), Nashville, TN. jason.sico@va.gov.
² From the VA Connecticut Health Care System (J.J.S., A.C.J., M.S., K.M.), West Haven Veterans Administration Medical Center, West Haven; Yale University School of Medicine (J.J.S., K.S.-A., A.C.J.), New Haven, CT; University of Pittsburgh School of Medicine (C.-C.H.C., K.L.K., A.A.B.); University of Pittsburgh Graduate School of Public Health (C.-C.H.C., L.H.K.), Pittsburgh, PA; Boston Medical Center (E.H.), MA; Emory University School of Medicine and Atlanta Veterans Administration Medical Center (D.R.), Atlanta, GA; David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System (M.B.G., D.L.), Los Angeles, CA; VA Pittsburgh Health Care System (A.A.B.), Pittsburgh, PA; Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine (M.C.R.-B.), Houston, TX; Washington DC Veterans Administration Medical Center and George Washington University School of Medicine (C.G.), Washington, DC; James J. Peters VA (S.T.B.), Bronx; Mount Sinai School of Medicine (S.T.B.), New York, NY; Boston University School of Medicine (J.S.), MA; Center for the Assessment of Pharmaceutical Practices (L.K.), Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research (L.K.), a Center for Innovation, Veterans Administration Medical Center, Bedford, MA; National Institute on Alcohol Abuse and Alcoholism (K.B.), Bethesda, MD; and Vanderbilt University School of Medicine and the Nashville Veterans Affairs Medical Center (M.S.F.), Nashville, TN.

PMID: 25862803
PMCID: PMC4433456
DOI: 10.1212/WNL.0000000000001560

Abstract

Objective: Given conflicting data regarding the association of HIV infection and ischemic stroke risk, we sought to determine whether HIV infection conferred an increased ischemic stroke risk among male veterans.

Methods: The Veterans Aging Cohort Study-Virtual Cohort consists of HIV-infected and uninfected veterans in care matched (1:2) for age, sex, race/ethnicity, and clinical site. We analyzed data on 76,835 male participants in the Veterans Aging Cohort Study-Virtual Cohort who were free of baseline cardiovascular disease. We assessed demographics, ischemic stroke risk factors, comorbid diseases, substance use, HIV biomarkers, and incidence of ischemic stroke from October 1, 2003, to December 31, 2009.

Results: During a median follow-up period of 5.9 (interquartile range 3.5-6.6) years, there were 910 stroke events (37.4% HIV-infected). Ischemic stroke rates per 1,000 person-years were higher for HIV-infected (2.79, 95% confidence interval 2.51-3.10) than for uninfected veterans (2.24 [2.06-2.43]) (incidence rate ratio 1.25 [1.09-1.43]; p < 0.01). After adjusting for demographics, ischemic stroke risk factors, comorbid diseases, and substance use, the risk of ischemic stroke was higher among male veterans with HIV infection compared with uninfected veterans (hazard ratio 1.17 [1.01-1.36]; p = 0.04).

Conclusions: HIV infection is associated with an increased ischemic stroke risk among HIV-infected compared with demographically and behaviorally similar uninfected male veterans.

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References

1. Freiberg M, Cheng DM, Kraemer KL, Saitz R, Kuller LH, Samet JH. The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals. AIDS 2007;21:193–197. - PMC - PubMed
1. Justice AC, Zingmond DS, Gordon K, et al. Drug toxicity, HIV progression, or comorbidity of aging: does tipranavir use increase the risk of intracranial hemorrhage? Clin Infect Dis 2008;47:1226–1230. - PubMed
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[1] Freiberg M, Cheng DM, Kraemer KL, Saitz R, Kuller LH, Samet JH. The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals. AIDS 2007;21:193–197. - PMC - PubMed

[2] Freiberg M, Cheng DM, Kraemer KL, Saitz R, Kuller LH, Samet JH. The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals. AIDS 2007;21:193–197. - PMC - PubMed

[3] Justice AC, Zingmond DS, Gordon K, et al. Drug toxicity, HIV progression, or comorbidity of aging: does tipranavir use increase the risk of intracranial hemorrhage? Clin Infect Dis 2008;47:1226–1230. - PubMed

[4] Justice AC, Zingmond DS, Gordon K, et al. Drug toxicity, HIV progression, or comorbidity of aging: does tipranavir use increase the risk of intracranial hemorrhage? Clin Infect Dis 2008;47:1226–1230. - PubMed

[5] Freiberg MS, Chang CH, Kuller LH. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 2013;173:614–622. - PMC - PubMed

[6] Freiberg MS, Chang CH, Kuller LH. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 2013;173:614–622. - PMC - PubMed

[7] Strategies for Management of Antiretroviral Therapy (SMART) Study Group, El-Sadr WM, Lundgren J, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006;355:2283–2296. - PubMed

[8] Strategies for Management of Antiretroviral Therapy (SMART) Study Group, El-Sadr WM, Lundgren J, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006;355:2283–2296. - PubMed

[9] D:A:D Study Group, Sabin CA, Worm SW, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 2008;371:1417–1426. - PMC - PubMed

[10] D:A:D Study Group, Sabin CA, Worm SW, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 2008;371:1417–1426. - PMC - PubMed

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HIV status and the risk of ischemic stroke among men

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HIV status and the risk of ischemic stroke among men

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