Stroke among highly active antiretroviral therapy-naive people living with the human immunodeficiency virus in China: a retrospective study of the characteristics, risk factors, and prognosis

Abstract

Background: We aimed to clarify the characteristics, risk factors, and prognosis of stroke among HAART-naive people living with HIV (PLWH) in China.

Methods: We selected HAART-naive PLWH admitted to Beijing Ditan Hospital, Capital Medical University, from 1 January 2009 to 31 December 2019. Demographic and clinical data were obtained by searching an anonymous electronic case system. Descriptive analysis and logistic regression and Cox proportional hazard models were used to determine the characteristics and predictors of stroke among all HAART-naive PLWH and evaluate the risk factors of mortality in HAART-naive PLWH with stroke.

Results: Stroke was diagnosed in 105 cases (3.7%) of 2867 HAART-naive PLWH. Multivariate logistic regression indicated that age of 30-55 years (OR 1.903, 95% CI 1.005-3.603, p = 0.048), age of ≥ 55 years (OR 4.104, 95% CI 1.928-8.737, p < 0.001), and CD4 count of < 200 cells/µL (OR 2.005, 95% CI 1.008-3.985, p = 0.047) were associated with increased odds of stroke. Diabetes (OR 3.268, 95% CI 1.744-6.125, p < 0.001), hypertension (OR 2.301, 95% CI 1.425-3.717, p = 0.001), syphilis (OR 2.003, 95% CI 1.300-3.089, p = 0.002), and complicated AIDS-defining CNS diseases (OR 7.719, 95% CI 4.348-13.703, p < 0.001) were risk factors for stroke. Of the 105 stroke patients, 12 (11.4%) died during hospitalisation, and the risk factors for mortality among patients with stroke were age of > 65 years (AHR: 8.783, 95% CI 1.522-50.668, p = 0.015), complicated severe pneumonia (AHR: 3.940, 95% CI 1.106-14.029, p = 0.034), and AIDS-defining CNS diseases (AHR: 19.766, 95% CI 3.586-108.961, p = 0.001).

Conclusions: For HAART-naive people living with HIV (PLWH), stroke occurred in various age groups, and early screening for stroke, timely intervention for risk factors among patients in various age groups, and controlling the CD4 count are extremely important in reducing the burden of stroke.

Keywords: HAART-naive; PLWH; Risk factors; Stroke.

Fig. 1

Histograms illustrating the age and CD4 stratifications. The proportions of stroke patients aged < 30, 30–55, and ≥ 55 years were 1.7%, 3.5%, and 9.4%, respectively. Among patients with CD4 cell counts of ≥ 200 and < 200 cells/µL, the proportions of stroke were 2.0% and 4.0%, respectively

Fig. 2

Histograms showing the mortality rates of stroke in HAART-naive people living with HIV (PLWH) stratified by age and CD4 count. Mortality rates associated with ages of < 30, 30–55, and ≥ 55 years were 0.2% (2 cases), 0.2% (4 cases), and 2.0% (6 cases), respectively. The mortality rates associated with CD4 counts of < 200 and ≥ 200 cells/µL were 0.5% (12 cases) and 0, respectively

Fig. 3

Kaplan–Meier survival curves for HAART-naive people living with HIV (PLWH) with/without severe pneumonia