Global and Regional Estimate of HIV-Associated Stroke Burden: A Meta-Analysis and Population Attributable Modeling Study

Abstract

BACKGROUND: This study aimed to determine the correlation between human-immunodeficiency-virus (HIV) infection and stroke, as well as to estimate the global, regional, and national burden of HIV-associated stroke. METHODS: A registered meta-analysis was performed by searching PubMed, Embase, and Web of Science for relevant literature up to October 31, 2022. The pooled relative risk of stroke in HIV-infected people was calculated using a random-effects model. HIV prevalence and disability-adjusted life years (DALYs) datasets were obtained from the Joint United Nations Program on HIV and AIDS, and the Global Health Data Exchange, respectively. The population attributable fraction was estimated and delivered to calculate the HIV-associated DALYs of stroke from 1990 to 2019, at the global, regional, and national levels. Pearson correlation analysis were conducted to assess the correlation between the age-standardized rate or estimated annual percentage changes and the sociodemographic index. RESULTS: Out of 10 080 identified studies, 11 were included in this meta-analysis. Compared with individuals without HIV-infection, the pooled relative risk of stroke in HIV-infected individuals was 1.40 (95% CI, 1.18–1.65). From 1990 to 2019, the global population attributable fraction of HIV-associated stroke increased almost 3-fold, while the HIV-associated DALYs increased from 18 595 (95% CI, 7485–31 196) in 1990 to 60 684 (95% CI, 24 281–101 894) in 2019. Meanwhile, HIV-associated DALYs varied by region, with Eastern and Southern Africa having the highest value of 126 160 in 2019. Moreover, countries with middle social development index were shouldering the highest increase trend of the HIV-associated DALYs age-standardized rates. CONCLUSIONS: HIV-infected individuals face a significantly higher risk of stroke, and the global burden of HIV-associated stroke has increased over the past 3 decades, showing regional variations. Eastern and Southern Africa bear the highest burden, while Eastern Europe and Central Asia have seen significant growth. Health care providers, researchers, and decision-makers should give increased attention to stroke prevention and management in HIV-endemic areas. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: CRD42022367450.

Cardiovascular Dynamics in HIV: The Influence of Adrenal Function and Nutritional Status

“…Improved access to efficacious ART regimens among PLHIV has transformed what was once a fatal illness into a chronic disease. As mortality from opportunistic infections typical of AIDS decreases, survivors now face increased vulnerability to CVDs, including hypertension, 108 atherosclerotic diseases such as myocardial infarction and stroke, 13,109 cardiomyopathy and heart failure, 110 aortic aneurysms, 111 and sudden cardiac death. 112 The mechanisms driving the excess risk for each disease have been extensively reviewed, highlighting traditional cardiometabolic risk factors, 113 such as glucose and lipid abnormalities, 114,115 as well as HIV-related factors, such as chronic immune activation and inflammation, 116,117 even in those who are virally suppressed.…”

Estimates of the global burden of non-Hodgkin lymphoma attributable to HIV: a population attributable modeling study

“…In addition, we aimed to provide an assessment of the global NHL burden attributed to HIV infection in individuals aged ≥15 years, using a population attributable fraction (PAF) model. 19 , 20 , 21 This assessment includes trends and disparities across various regions and countries. Moreover, we also explore the potential relationship between the burden of HIV-associated NHL and sociodemographic factors.…”

Exercise to Prevent Accelerated Vascular Aging in People Living With HIV

“…4 Thus, the widespread uptake of ART has altered the disease trajectory of HIV to that of a manageable chronic condition for many. 5,6 Globally, cardiovascular diseases (CVDs), such as myocardial infarction, peripheral arterial disease, and stroke are now the leading cause of death in PLWH [7][8][9] ; furthermore, PLWH have approximately twice the risk of developing CVD as the general population, with CVD tripling between 1990 and 2015 in PLWH. 7,10 Indeed, the current guidelines recommended by the American College of Cardiology/American Heart Association are to consider HIV as a risk-enhancing factor when estimating CVD risk.…”

“…7,10 Indeed, the current guidelines recommended by the American College of Cardiology/American Heart Association are to consider HIV as a risk-enhancing factor when estimating CVD risk. 9 Despite the well-recognized associations between HIV and CVD, the causes of the increased CVD incidence are not fully understood. 6,8 Evidence points to both traditional risk factors, such as dyslipidemia and hypertension, and nontraditional risk factors such as vascular dysfunction due to excess burden of inflammation 11 and oxidative stress 12 that are likely related to the pathophysiology of HIV itself but also the side effects of ART.…”