Short Communication: Incidence and Risk Factors of Ischemic Stroke and Transient Ischemic Attack Among People Living with HIV: A Longitudinal Cohort Study

Abstract

People living with HIV (PLWH) have higher ischemic cerebrovascular disease rates than HIV-negative individuals. We aimed to determine the incidence and risk factors of ischemic stroke (IS) and transient ischemic attack (TIA) among Thai PLWH. Data from adults living with HIV who were enrolled in a prospective HIV-NAT 006 cohort in Bangkok, Thailand, from 1996 to 2020 were included in the analysis. The primary endpoint was first-ever IS or TIA. Among 2020 PLWH included in the analysis, 16 (0.8%) developed first-ever IS/TIA over 23,579 person-years (incidence: 0.7 per 1,000 person-years [95% confidence interval {CI} 0.4-1.1]). Median CD4 cell counts before developing IS/TIA was 480 cells/mL and 87.5% were virologically suppressed. In multivariate models, hypertension was the only factor significantly associated with IS/TIA incidence (adjusted subhazard ratio 4.4; 95% CI 1.2-15.6, p = .02). The incidence of IS/TIA was low among well-suppressed Thai PLWH. Traditional risk factors, particularly hypertension, still play an essential role in developing IS/TIA.

Keywords: HIV; Thailand; epidemiology; incidence; ischemic stroke; transient ischemic attack.