Ischemic Stroke and Older AIDS Patients

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A new study in HIV Medicinehas found that previous or current use of illegal drugs, uncontrolled HIV infection, and some traditional vascular risk factors are associated with ischemic cerebral events in aging people with AIDS.

In a case-control study of 2146 HIV-infected patients followed in the authors’ clinic, those hospitalized between January 2006 and June 2014 with an ischemic stroke or TIA were compared with age-matched and gender-matched controls without stroke.

The study included 20 men and 3 women (mean age 51.3 years) and 23 controls. Among the cases, 83% had had a stroke and 17% a TIA. Small-vessel occlusion was the most frequent etiology, followed by large-artery atherosclerosis, and cardioembolism.

Stroke was statistically significantly associated with diabetes, smoking, and low concentrations of HDL cholesterol as compared with controls. Illegal drug use, a low CD4 count, and a high viral load were also associated with ischemic cerebral events.

There were no statistically significant differences between cases and controls in CDC HIV stage, CD4 count nadir, and HIV infection time-to-event. No statistically significant differences were found concerning ART or treatment compliance.

The authors wrote that “The paradigm of the care of HIV-infected patients is changing. Concomitant diseases in the aging 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.”

Few studies have compared HIV-infected patients with and without stroke. “Only by comparing two samples of patients exposed to HIV infection can we address specific factors responsible for stroke in the HIV-infected population,” the authors stated. Because this was a single-center, retrospective study with a small number of cases, multivariate analysis was not performed.

The reason why HIV replication causes stroke is not yet known. “Interactions between HIV, ART, illegal drugs, coinfections, opportunistic infections and vascular risk factors are very complex and hard to analyze,” the authors noted.