Types of Stroke Among People Living With HIV in the United States.
Journal of acquired immune deficiency syndromes
washington; seattle; swedish neuro
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.
Neurosciences (Brain & Spine)
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; and Tirschwell, David L, "Types of Stroke Among People Living With HIV in the United States." (2021). Articles, Abstracts, and Reports. 4506.