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Ischaemic stroke in HIV-infected patients: a case-control study
A Silva-Pinto1,2, A Costa3,4, R Serrão1,2
1Infectious Diseases Department and HIV Clinic, Centro Hospitalar São João, Porto, Portugal.
Insights
HIV patients experiencing ischaemic stroke were linked to illegal drug use, high viral load, and traditional vascular risks like diabetes and smoking. Managing these factors alongside HIV is crucial for preventing cerebrovascular events.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- HIV infection is associated with increased cerebrovascular disease risk.
- Antiretroviral therapy (ART) has transformed HIV management but long-term effects on vascular health require ongoing study.
- Understanding stroke risk factors in HIV-infected individuals is critical for comprehensive patient care.
Purpose of the Study:
- To investigate the roles of HIV infection stage, ART, and vascular risk factors in ischaemic stroke among HIV-infected patients.
- To identify specific factors contributing to cerebrovascular events in this population.
Main Methods:
- A case-control study comparing HIV-infected patients with ischaemic stroke or transient ischaemic attack (TIA) to matched controls without stroke.
- Data collected from patients followed at a single clinic between January 2006 and June 2014.
Main Results:
- Ischaemic stroke was significantly associated with diabetes, smoking, low high-density lipoprotein (HDL) cholesterol, illegal drug use, low CD4 count, and high viral load.
- Small-vessel occlusion was the most common stroke aetiology, followed by large-artery atherosclerosis and cardioembolism.
- No significant differences were observed in HIV stage, nadir CD4 count, HIV duration, ART use, or treatment compliance between cases and controls.
Conclusions:
- Illegal drug use, uncontrolled HIV replication, and traditional vascular risk factors are associated with ischaemic cerebral events in HIV-infected patients.
- Cerebrovascular disease is an important comorbidity in aging HIV patients and requires proactive management.
- Comprehensive care for HIV-infected individuals must include managing vascular risk factors in addition to controlling HIV infection with ART.
Objectives:
The aim of the study was to provide insights into the contributions of HIV infection stage, antiretroviral therapy (ART) and vascular risk factors to the occurrence of ischaemic stroke in HIV-infected patients.
Methods:
We performed a case-control study of HIV-infected patients followed in our clinic. We compared patients hospitalized between January 2006 and June 2014 with an ischaemic stroke or transient ischaemic attack to age- and gender-matched controls without stroke.
Results:
Of 2146 patients followed in our clinic, we included 23 cases (20 men and three women; mean age 51.3 years) and 23 controls. Eighty-three per cent of cases had had a stroke and 17% a transient ischaemic attack. According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, small-vessel occlusion was the most frequent aetiology, followed by large-artery atherosclerosis and cardioembolism. Compared with controls, stroke was statistically significantly associated with diabetes, smoking and low concentrations of high-density lipoprotein (HDL) cholesterol. Illegal drug use, a low CD4 count and a high viral load were also associated with ischaemic cerebral events. There were no statistically significant differences between cases and controls in Centers for Disease Control and Prevention (CDC) HIV stage, CD4 count nadir and HIV infection time-to-event. No statistically significant differences were found concerning ART or treatment compliance.
Conclusions:
In our single centre study, we found associations of illegal drug use, HIV replication and some traditional vascular risk factors with the occurrence of ischaemic cerebral events. The paradigm of the care of HIV-infected patients is changing. Concomitant diseases in the ageing patient with HIV infection, including cerebrovascular disease, must also be addressed in view of their impacts on morbidity and mortality. Apart from controlling the HIV infection and immunosuppression with ART, vascular risk factors must also be addressed.
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