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Types of Stroke Among People Living With HIV in the United States
Heidi M Crane1, Robin M Nance1, Tigran Avoundjian2
1Medicine, University of Washington, Seattle, WA.
Insights
Stroke is common in people with HIV (PLWH), with ischemic strokes often linked to infections or drug use. Understanding these precipitating factors is key to preventing strokes in this population.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Most studies on stroke in people living with HIV (PLWH) lack verified diagnoses and do not differentiate stroke types.
- Existing research is often limited by small sample sizes.
Purpose of the Study:
- To implement a centralized stroke adjudication protocol to identify stroke type, subtype, and precipitating conditions in a large, diverse HIV cohort.
- To analyze the characteristics of stroke subtypes and associated risk factors in PLWH.
Main Methods:
- A centralized adjudication stroke protocol was applied to a large U.S. multisite clinical cohort of PLWH (CNICS).
- Stroke type, subtype, and direct causes (e.g., infection, drug use) were identified.
- Data from 26,514 PLWH, including 401 stroke cases, were analyzed.
Main Results:
- Ischemic strokes accounted for 75% of all strokes in PLWH.
- Precipitating factors like sepsis or cocaine use were identified in 40% of ischemic strokes.
- Common ischemic stroke subtypes included small vessel (24%), cardioembolic (20%), and large vessel atherosclerosis (13%).
Conclusions:
- Ischemic stroke, especially small vessel and cardioembolic types, is prevalent in PLWH.
- Risk factors, both traditional and HIV-related, vary by stroke type/subtype.
- Precipitating factors, including infections and drug use, are significant and warrant further investigation for stroke prevention strategies in PLWH.
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.
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