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. 2021 Apr 15;86(5):568-578.
doi: 10.1097/QAI.0000000000002598.

Types of Stroke Among People Living With HIV in the United States

Heidi M Crane  1 , Robin M Nance  1 , Tigran Avoundjian  2 , Barbara N Harding  1   3   4   2   5   6   7   8   9   10   11 , Bridget M Whitney  1 , Felicia C Chow  3 , Kyra J Becker  4 , Christina M Marra  1   4 , Joseph R Zunt  1   4   2 , Emily L Ho  4   5 , Rizwan Kalani  4 , Andrew Huffer  4 , Greer A Burkholder  6 , Amanda L Willig  6 , Richard D Moore  7 , William C Mathews  8 , Joseph J Eron  9 , Sonia Napravnik  9 , William B Lober  10 , Greg S Barnes  10 , Justin McReynolds  10 , Matthew J Feinstein  2 , Susan R Heckbert  2 , Michael S Saag  6 , Mari M Kitahata  1 , Joseph A C Delaney  2   11 , David L Tirschwell  4
Affiliations

Types of Stroke Among People Living With HIV in the United States

Heidi M Crane et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes.

Setting: CNICS, a U.S. multisite clinical cohort of PLWH in care.

Methods: We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort.

Results: Among 26,514 PLWH, there were 401 strokes, 75% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20%), large vessel atherosclerosis (13%), and small vessel (24%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes.

Conclusion: Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Stroke ascertainment and adjudication at five sites across the United States in the CNICS cohort
Figure 2.
Figure 2.
Stroke types and ischemic stroke subtypes among people living with HIV at 5 sites across the United States in the CNICS cohort
See this image and copyright information in PMC

Comment in

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