Incidence and Clinical Features of Cerebrovascular Disease Among HIV-Infected Adults in the Southeastern United States

Abstract

With aging of the HIV-infected population, non-AIDS conditions such as cardiovascular disease (CVD) now account for substantial mortality and morbidity. While myocardial infarction is the major outcome of interest in the field of HIV and CVD, cerebrovascular disease remains understudied, especially in the Southeastern United States. We determined the incidence and clinical features of cerebrovascular events (CVE) in a large HIV clinical cohort in North Carolina (NC). A total of 2,515 HIV-infected adults contributed a median of 4.5 years (IQR: 2.0, 7.8) of follow-up. Fifty-three CVEs were adjudicated for an incidence rate of 3.87 per 1,000 person-years (95% CI: 2.90, 5.06). The ischemic stroke incidence was 2.26 per 1,000 person-years (95% CI: 1.53, 3.21), approximately 1.5 times the rate of a population-based cohort in NC. At the time of CVE, the median age was 48 years (IQR: 42, 55). Of ischemic strokes 76% resulted from large artery atherosclerosis or small vessel (lacunar) disease. In multivariable analyses, age, hypertension, dyslipidemia, recent CD4 + cell count £ 200 cells/mm 3 , and recent HIV RNA > 400 copies/ml were associated with an increased risk of CVE. Antiretroviral therapy (ART) was not associated with the risk of CVE. We concluded that in the post-ART era, HIV-infected individuals appear to be at moderately increased risk of stroke. Prevention of CVEs in this population will require modification of traditional CVD risk factors and early, effective treatment of HIV infection.

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

“…[30][31][32][33][34][35][36][37] Existing data conflict regarding the specific association between CD4 count and cerebrovascular and cardiovascular risk. 5,6,33,38,39 Similar to our finding that a CD4 count ,200 3 10 6 cells/L was associated with higher ICH risk, we previously found a higher CD4 count decreased the hazard of ischemic stroke, although this did not reach statistical significance. 5 Furthermore, ART use, for which there is mixed evidence in relation to stroke risk, 5,6,9,38 was associated with a lower, but not statistically significant, hazard of ICH (table 5).…”

“…5,6,33,38,39 Similar to our finding that a CD4 count ,200 3 10 6 cells/L was associated with higher ICH risk, we previously found a higher CD4 count decreased the hazard of ischemic stroke, although this did not reach statistical significance. 5 Furthermore, ART use, for which there is mixed evidence in relation to stroke risk, 5,6,9,38 was associated with a lower, but not statistically significant, hazard of ICH (table 5). These findings suggest that more advanced or less wellcontrolled HIV infection may contribute to increased cerebrovascular risk.…”

“…As with myocardial infarction and ischemic stroke, 1,3,5,38 the absolute rates of ICH among HIVinfected individuals increased with older age. In the overall cohort, however, we demonstrated that the effect of HIV status on the hazard of ICH decreased as age increased.…”

Obesity Is Associated with Race/Sex Disparities in Diabetes and Hypertension Prevalence, But Not Cardiovascular Disease, Among HIV-Infected Adults

“…[1][2][3][4][5][6] People living with HIV (PLWH) in the United States are now diagnosed with a number of age-related chronic conditions including cardiovascular disease, renal disease, and diabetes at rates at least as great as and often greater than those of HIV-uninfected populations. [7][8][9][10][11][12] A striking increase in obesity [body mass index (BMI) ‡30 kg/m is known regarding the associations of race, sex, and obesity with CMD risk. Therefore, in the present study we compared the prevalence of CMD and obesity by race/sex among a crosssectional cohort of PLWH, and evaluated whether obesity impacts the associations between race/sex and CMD.…”

Persistent HIV-1 replication is associated with lower antiretroviral drug concentrations in lymphatic tissues

“…Levels of T-cell activation and innate system activation are often higher than that observed in well-matched uninfected adults (5,6). These persistent abnormalities may contribute to abnormal vaccine responses (7,8), a higher than normal incidence of non-AIDS-related cancers (9,10) and increased risk for clinical conditions associated with chronic inflammation (e.g., cardiac disease, clotting disorders, pulmonary hypertension, emphysema, and stroke) (11)(12)(13)(14)(15)(16)(17)(18). Thus, improvements over current approaches to treatment of HIV infection that more fully restore normal immune function might significantly improve health and life expectancy.…”