Increasing incidence of ischemic stroke in patients with HIV infection. Neurology

Stroke Center and Department of Neuroscience, University of California at San Diego, 200 West Arbor Drive, MC 8466, San Diego, CA 92103-8466, USA.
Neurology (Impact Factor: 8.29). 02/2011; 76(5):444-50. DOI: 10.1212/WNL.0b013e31820a0cfc
Source: PubMed


Large-scale epidemiologic data on stroke in HIV-infected persons are scarce, especially in an era of combination antiretroviral therapies, which have prolonged patient survival, but may boost stroke risk. We assessed trends in the proportion of HIV infection among patients with stroke in the United States.
Data were obtained from all states within the United States that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a primary discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes) were included. Time trends in the proportion of these patients with HIV diagnosis were computed, and independent predictors of comorbid HIV diagnosis evaluated using multivariable logistic regression.
Of all (ischemic and hemorrhagic) stroke hospitalizations, patients with comorbid HIV infection constituted 0.09% in 1997 vs 0.15% in 2006 (p < 0.0001). Actual numbers of overall US stroke hospitalizations lessened 7% (998,739 to 926,997), while actual numbers of stroke hospitalizations with coexisting HIV infection rose 60% (888 to 1,425). Patients with comorbid HIV infection comprised 0.08% of ischemic strokes in 1997 vs 0.18% in 2006 (p < 0.0001), but their proportion of hemorrhagic strokes did not significantly change. Factors independently associated with higher odds of comorbid HIV diagnosis were Medicaid insurance, urban hospital type, dementia, liver disease, renal disease, and cancer.
Over the last decade in the United States, there has been a substantial and significant rise in patients hospitalized for stroke with coexisting HIV infection. This has important public health and socioeconomic consequences.

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    • "The mechanisms underlying this association are not fully understood. There is evidence, however , that the in the era of effective anti-retroviral (ARV) therapy, the aging population with HIV infection has an increasing prevalence of vascular events and dementia as a major cause of morbidity and mortality (Hassler, 1962; Connor et al., 2000; Triant et al., 2007; Ovbiagele and Nath, 2011). Multiple mechanisms have been invoked to try to explain this phenomenon. "
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    • "In the United States, stroke risk in human immunodeficiency virus- (HIV-) infected patients increased 60% over the decade from 1997 through 2006 [1]. Since the emergence of AIDS in 1981, substantial advances in our understanding of the acquired immune deficiency syndrome (AIDS) have been achieved. "
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    • "Increased prevalence of strokes in HIV-infected individuals Approximately one third to half of older people have had infarcts; many of whom do not show cognitive deficits (Schneider et al. 2009), probably due to their cognitive reserve. HIV infection is also associated with an increased risk of stroke (Cole et al. 2004; Qureshi et al. 1997), up by 60 % between 1997 and 2006 in stroke patients with the coexisting diagnosis of HIV (Ovbiagele and Nath 2011). Treatment with protease inhibitors may further increase the incidence of vascular events. "
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