Elevated ischemic stroke risk among women living with HIV infection

Chow, Felicia C.; Regan, Susan; Zanni, Markella V.; Looby, Sara E; Bushnell, Cheryl; Meigs, James B.; Grinspoon, Steven; Feske, Steve K.; Triant, Virginia A.

doi:10.1097/qad.0000000000001650

Cited by 64 publications

(55 citation statements)

References 39 publications

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“…Similarly, these findings may also be found in other developing countries. After adjusting for vascular risk factors, an increased risk of stroke in HIV patients has been found in both men29 and women 30. Possible mechanisms of stroke in HIV-patients are changes in coagulation state, cardioembolism, HIV-associated vasculitis, HIV-associated vasculopathies and mycotic aneurysms 31…”

Section: Epidemiology and Stroke Aetiology From A Global Perspectivementioning

confidence: 99%

Ischaemic stroke in young adults: a global perspective

Boot¹,

Ekker²,

Putaala

et al. 2020

J Neurol Neurosurg Psychiatry

169

147

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Ischaemic stroke at young age is an increasing problem in both developing and developed countries due to rising incidence, high morbidity and mortality and long-term psychological, physical and social consequences. Compared with stroke in older adults, stroke in young adults is more heterogeneous due to the wide variety of possible underlying risk factors and aetiologies. In this review, we will provide an overview of the global variation in the epidemiology of stroke in young adults, with special attention to differences in geography, ethnicity/race and sex, as well as traditional and novel risk factors for early-onset ischaemic stroke, such as air pollution. Understanding global differences is an important prerequisite for better region-specific prevention and treatment of this devastating condition.

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Section: Epidemiology and Stroke Aetiology From A Global Perspectivementioning

confidence: 99%

Ischaemic stroke in young adults: a global perspective

Boot¹,

Ekker²,

Putaala

et al. 2020

J Neurol Neurosurg Psychiatry

169

147

View full text Add to dashboard Cite

show abstract

“…In their cohort, 78% of subjects were on PI. Chow et al found a two-fold increase in ischemic stroke in HIV-reactive women compared with healthy controls [18]. Similarly, HIV + individuals on PI had higher Fg values than those in the control group, probably due to drug action [16,56,62].…”

Section: Discussionmentioning

confidence: 97%

“…Chronic infection of HIV promotes changes in hemostasis and coagulation inconsequence of persistent systemic immune activation, micro-and macro-vascular disease, and, potentially, impaired hepatic synthesis of coagulation factors [17]. Futhermore, in these patients, the aging process starts early compared to the general population, due to the increase of complicating factors and other diseases [18][19][20]. Markers of biological and cellular aging are common in HIV-reactive patients [21].…”

Section: Introductionmentioning

confidence: 99%

Hemostasis in elderly patients with human immunodeficiency virus (HIV) infection—Cross-sectional study

et al. 2020

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Introduction: Aging and chronic HIV infection are clinical conditions that share the states of inflammation and hypercoagulability. The life expectancy of the world population has increased in the last decades, bringing as complications the occurrence of diseases that undergoing metabolic, bone, cardiological, vascular and neurological alterations. HIVinfected patients experience these changes early and are living longer due to the success of antiretroviral therapy. The objectives of this study was to evaluate some changes in the plasma hemostatic profile of 115 HIV-reactive elderly individuals over 60 years old in the chronic phase of infection, and compare with 88 healthy uninfected elderly individuals. Plasma determinations of D-dimers, Fibrinogen, von Willebrand Factor, Antithrombin, Prothrombin Time, Activated Partial Thromboplastin Time, and platelet count were performed. In the HIV-reactive group, these variables were analyzed according to viral load, protease inhibitor use and CD4 + T lymphocyte values. After adjusted values for age and sex, the results showed higher levels of Antithrombin (103%; 88%, p = 0.0001) and Prothrombin Time activities (92.4%; 88.2%, p = 0.019) in the HIV group compared to the control group. We observed higher values of Fibrinogen in protease inhibitor users in both the male (p = 0.043) and female (p = 0.004) groups, and in the female HIV group with detected viral load (p = 0.015). The male HIV group with a CD4 + count> 400 cells / mm 3 presented higher von Willebrand Factor values (p = 0.036). D-Dimers had higher values in the older age groups (p = 0.003; p = 0.042, respectively). Conclusion: Our results suggest that the elderly with chronic HIV infection with few comorbidities had a better hemostatic profile than negative control group, reflecting the success of treatment. Protease inhibitor use and age punctually altered this profile.

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“…In the Partners cohort, the association between HIV and elevated ischemic stroke risk in women was still present after accounting for traditional vascular risk factors and sex-specific risk factors, including menopause status, estrogen use, history of pregnancy, hypercoagulable disorders, migraines, and a history of depression or anxiety. 38 However, the study's reliance on administrative billing codes to define these risk factors, including menopause, which is inadequately captured by billing codes, challenges the validity of these findings. In the ALLRT cohort, the higher risk of stroke in women compared with men was primarily observed in the 40-to 49-year age group, posing the question of whether hormonal changes (i.e., estrogen depletion) during the perimenopause transition could be a particularly high-risk time for cerebrovascular health in women living with HIV.…”

Section: Potential Mechanisms For Sex Differences In Cerebrovascular mentioning

confidence: 99%

Sex Matters in Neuroinfectious Diseases

Chow

2017

Semin Neurol

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Although sex and gender have a major impact on the susceptibility and immunologic response to infectious diseases, these factors are often neglected. Identifying the mechanisms underlying sex-based differences in infectious diseases will facilitate the rational design and implementation of preventive and therapeutic strategies that reduce risk and improve outcomes for women and men. In this article, we discuss two examples in neuroinfectious diseases of how sex matters: (1) the heightened risk of cerebrovascular disease in women living with HIV infection and (2) the implications of Zika virus infection on sexual and reproductive health and vaccine development for women.

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Elevated ischemic stroke risk among women living with HIV infection

Cited by 64 publications

References 39 publications

Ischaemic stroke in young adults: a global perspective

Ischaemic stroke in young adults: a global perspective

Hemostasis in elderly patients with human immunodeficiency virus (HIV) infection—Cross-sectional study

Sex Matters in Neuroinfectious Diseases

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