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. 2018 Jun 1;32(9):1125-1135.
doi: 10.1097/QAD.0000000000001799.

Stroke incidence is highest in women and non-Hispanic blacks living with HIV in the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort

Felicia C Chow  1   2 , Michael R Wilson  1   3 , Kunling Wu  4 , Ronald J Ellis  5 , Ronald J Bosch  4 , Benjamin P Linas  6
Affiliations

Stroke incidence is highest in women and non-Hispanic blacks living with HIV in the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort

Felicia C Chow et al. AIDS. .

Abstract

Objective: To investigate the incidence of first-ever stroke/transient ischemic attack (TIA) and associated risk factors in a cohort of persons living with HIV infection (PLWH).

Design: Observational cohort study

Methods: We determined incidence rates of first-ever stroke/TIA in PLWH after ART initiation from the AIDS Clinical Trials Group ALLRT cohort and its parent trials. Poisson regression models evaluated baseline and time-varying covariates as risk factors for stroke/TIA.

Results: The incidence rate of stroke/TIA was 1.69 per 1000 person-years. Incidence rates were highest in women (2.88 stroke/TIAs per 1000 person-years compared with 1.40 per 1000 person-years in men) and non-Hispanic Blacks (2.51 stroke/TIAs per 1000 person-years compared with 0.77 per 1000 person-years in Hispanic/other race/ethnicities and 1.56 per 1000 person-years in whites). In a multivariable model, we found a significant age-by-sex interaction (P = 0.01). The higher risk of stroke/TIA in women was more pronounced at younger ages, whereas older age conferred a greater increase in stroke/TIA risk in men than women. Other risk factors for stroke/TIA included hypertension, higher LDL, and HIV RNA greater than 200 copies/ml. Overweight/obese BMI and higher CD4+:CD8+ ratio protected against stroke/TIA.

Conclusion: Women and non-Hispanic Blacks living with HIV had the highest incidence rates of stroke/TIA. A concerted effort must be made to include PLWH from these at-risk groups in observational and interventional studies aimed at understanding stroke mechanisms and reducing stroke risk in HIV infection. Strategies to modify stroke risk in PLWH should employ a multipronged approach targeting vascular risk factors and engaging and retaining patients in HIV care.

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Figures

Figure 1
Figure 1
Rates of stroke/TIA with 95% confidence intervals by time-updated age, sex and race/ethnicity. A. Rates of stroke/TIA by age group B. Rates of stroke/TIA with 95% confidence intervals by sex C. Rates of stroke/TIA with 95% confidence intervals by race/ethnicity D. Rates of stroke/TIA with 95% confidence intervals by time-updated age and sex
Figure 1
Figure 1
Rates of stroke/TIA with 95% confidence intervals by time-updated age, sex and race/ethnicity. A. Rates of stroke/TIA by age group B. Rates of stroke/TIA with 95% confidence intervals by sex C. Rates of stroke/TIA with 95% confidence intervals by race/ethnicity D. Rates of stroke/TIA with 95% confidence intervals by time-updated age and sex
Figure 2
Figure 2
Multivariable model of relative risk of stroke/TIA in ALLRT cohort. Model adjusted for all variables shown in the figure and age-by-sex interaction.
See this image and copyright information in PMC

References

    1. 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. - PMC - PubMed
    1. Chow FC, He W, Bacchetti P, Regan S, Feske SK, Meigs JB, et al. Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort. Neurology. 2014;83:1705–1711. - PMC - PubMed
    1. Rasmussen LD, Engsig FN, Christensen H, Gerstoft J, Kronborg G, Pedersen C, et al. Risk of cerebrovascular events in persons with and without HIV. AIDS. 2011;25:1637–1646. - PubMed
    1. Marcus JL, Leyden WA, Chao CR, Chow FC, Horberg MA, Hurley LB, et al. HIV infection and incidence of ischemic stroke. AIDS. 2014;28:1911–1919. - PubMed
    1. Sico JJ, Chang C-CH, So-Armah K, Justice AC, Hylek E, Skanderson M, et al. HIV status and the risk of ischemic stroke among men. Neurology. 2015;84:1933–1940. - PMC - PubMed

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