Incidence of stroke in patients with HIV infection: A population-based study in Taiwan

Abstract

Background Few studies have evaluated whether people infected with human immunodeficiency virus (HIV) are at an increased risk of stroke in an Asian population. We investigated the association between HIV infection and the risk of developing stroke by age, calendar year of HIV diagnosis, and follow-up duration in Taiwan. Methods Using the claims data of a universal health insurance program, we identified 5,961 patients with HIV and 23,844 matched non-HIV subjects without previous stroke from 1998 to 2005 and followed them up until the end of 2011 to measure the incidence of stroke. Cox proportional hazards models adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), with the non-HIV group as reference. Results During a median follow-up of 8 years, the incidence rates for total, ischemic, and hemorrhagic stroke per 1000 person-years were 2.12, 1.22, and 0.60, respectively, in patients with HIV infection, and 1.98, 1.14, and 0.54, respectively, in the comparison group. HIV infection was associated with an elevated risk of developing total stroke (adjusted HR [95% CI], 1.57 [1.15–2.14]) and ischemic stroke (1.91 [1.25–2.91]) in patients aged less than 45 years, but no association was observed in other age groups ( P for interaction with age, p = 0.048 and 0.024, respectively). Patients diagnosed with HIV infection in 1998–1999 had a greater HR for total stroke and ischemic stroke than those diagnosed in 2000–2002 and 2003–2005 ( P for interaction, for total stroke p = 0.034, for ischemic stroke p = 0.056). The HRs did not differ by follow-up duration. Conclusions HIV infection among a young age group is associated with increased risk of developing overall and ischemic stroke. The findings highlight the importance of screening and correcting risk factors for young stroke prevention immediately and aggressively.

Metabolic Syndrome and Cardiovascular Disease Impacts on the Pathophysiology and Phenotype of HIV-Associated Neurocognitive Disorders

“…In Europe, PLHIVs have a slightly lower stroke incidence than in the USA, consistent with lower rates seen in the general population of Europe compared to the USA (Vinikoor et al 2013;Corral et al 2009). More recent studies revealed a decline in the stroke risk among PLHIVs in recent years after the introduction of cART (Alvaro-Meca et al 2017;Lin et al 2019). There may be many reasons for this decline: adverse events associated with older antiretroviral regimens or more effective cART in the recent era, higher CD4+ T-cell nadir, lower frequency of opportunistic infections, and overestimated misdiagnoses due to limited diagnostic tests during the earlier period of the infection.…”

Elevated plasma von Willebrand factor levels are associated with subsequent ischemic stroke in persons with treated HIV infection

“…Notably, although an increasing burden of morbidity and mortality due to stroke is likely as PWH age, ischemic stroke risk may be highest in younger PWH compared with age-matched controls. In a population-based study in Taiwan, HIV infection was associated with an elevated risk of developing any stroke (adjusted hazard ratio [AHR], 1.57; 95% CI, 1.15–2.14) and specifically ischemic stroke (AHR, 1.91; 95% CI, 1.25–2.91) in patients 45 years of age and younger, but no association was observed in older age groups [ 39 ]. While some data suggest that the newer INSTI-based regimens may be associated with a lower risk of ischemic stroke than older NNRTI- and PI-based regimens [ 40 ], our study population included only 8 participants (6.4%; 3 cases and 5 controls) with regimens including the first approved INSTI (ie, raltegravir), and our method of matching by regimen precluded analysis of regimen type as a predictor.…”

Stroke in Patients With Hiv Infection

“…Результаты нейровизуализационных исследований у пациентов с ВИЧ-инфекцией и ГИ указывали Считается, что развитие сосудистых осложнений при ВИЧ-инфекции происходит преимущественно в более поздние стадии заболевания, и чем меньше уровень CD4-лимфоцитов, тем чаще у больных возникает инсульт [14,15]. Тем не менее имеются единичные работы, указывающие на высокий риск инсульта у ВИЧ-инфицированных лиц молодого возраста даже при достаточном уровне CD4-лимфоцитов с развитием инсульта через год после диагностирования ВИЧ-инфекции [8], что согласуется с нашими данными. У пациентов группы 1 в 3 субклинической стадии инсульт развился при достаточно высоком уровне CD4-лимфоцитов с диапазоном колебаний их уровня от 1540 до 504 кл./мкл.…”

“…На 1 января 2019 года общее количество зараженных ВИЧ составило 1,3 млн человек [3]. По частоте поражения органов и систем при ВИЧ-инфекции нервная система стоит на втором месте после иммунной системы [4], и на долю ОНМК приходится 1-5% всех поражений нервной системы [5][6][7][8][9]. Встречаемость инсультов у лиц моложе 45 лет со СПИДом в 10 раз выше, чем в общей популяции у лиц того же возраста [10].…”