Types of Stroke Among People Living With HIV in the United States. (15th April 2021)

• Record Type: Journal Article
• Authors: Crane, Heidi M.; Nance, Robin M.; Avoundjian, Tigran; Harding, Barbara N.; Whitney, Bridget M.; Chow, Felicia C.; Becker, Kyra J.; Marra, Christina M.; Zunt, Joseph R.; Ho, Emily L.; Kalani, Rizwan; Huffer, Andrew; Burkholder, Greer A.; Willig, Amanda L.; Moore, Richard D.; Mathews, William C.; Eron, Joseph J.; Napravnik, Sonia; Lober, William B.; Barnes, Greg S.; McReynolds, Justin; Feinstein, Matthew J.; Heckbert, Susan R.; Saag, Michael S.; Kitahata, Mari M.; Delaney, Joseph A.C.; Tirschwell, David L.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 86:Number 5(2021)
• Publication Date: 2021-04-15
• Subjects: HIV -- stroke -- ischemic stroke -- hemorrhagic stroke -- stroke subtypes; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002598
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes. Setting: CNICS, a U.S. multisite clinical cohort of PLWH in care. Methods: We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort. Results: Among 26, 514 PLWH, there were 401 strokes, 75% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20%), large vessel atherosclerosis (13%), and small vessel (24%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes. Conclusion: Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.