First-ever acute ischemic strokes in HIV-infected persons: A case-control study from stroke units

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Persons living with human immunodeficiency virus (PLHIVs) have a doubled risk of stroke compared to HIV-uninfected individuals.
• Data on stroke-unit access, reperfusion therapy use, and outcomes for PLHIVs experiencing acute ischemic stroke (AIS) are limited.

Purpose of the Study:

• To compare stroke characteristics and outcomes between PLHIVs and HIV-uninfected controls (HUCs).
• To identify factors influencing AIS risk and outcomes in PLHIVs.
• To evaluate the management and tolerability of neurovascular care and reperfusion therapy in PLHIVs.

Main Methods:

• Retrospective screening of AIS patients from the National Hospitalization Database in Paris-area stroke units (2017-2021).
• Comparison of PLHIVs with age-, initial NIHSS-, and sex-matched HUCs.
• Assessment of 90-day modified Rankin Scale score as the primary outcome.

Main Results:

• PLHIVs had a higher rate of previously unknown AIS detected by MRI compared to HUCs (p=0.006).
• Common stroke causes in PLHIVs included large artery atherosclerosis, undetermined, and cardioembolism; none were linked to HIV duration or viral load.
• Both PLHIVs and HUCs exhibited suboptimal control of cardiovascular risk factors (hypertension, diabetes, dyslipidemia).
• Stroke outcomes were comparable between groups, with prognosis linked to initial NIHSS and reperfusion therapy.

Conclusions:

• A significant proportion of PLHIVs presented with uncontrolled HIV infection and suboptimal cardiovascular risk factor management.
• Enhanced vigilance for HIV suppression, antiretroviral adherence, and cardiovascular risk factor prevention is recommended, particularly for younger PLHIVs.
• Implementing preventive measures may reduce the risk of AIS in PLHIVs.