HIV and Stroke

"The proportion of hospitalized stroke patients who are HIV-infected is increasing; multiple reasons are likely.

Although HIV infection and specific antiretroviral agents have been linked to cardiovascular disease, little is known about the incidence of stroke in HIV-infected patients. To explore this topic, investigators examined time trends in the proportion of hospitalized stroke patients who have HIV infection.

The researchers analyzed data from the Nationwide Inpatient Sample, which includes discharge information on a large number of patients hospitalized throughout the U.S. They used ICD-9 codes to identify hospitalizations for stroke and applied a weighting factor to correct for potential overascertainment. They derived rate denominators from U.S. census data, including for the total number of persons living with HIV.

Between 1998 and 2006, the stroke-hospitalization rate in the general HIV-negative population decreased by 17% (from 375 to 311 per 100,000 persons). In contrast, the rate in the HIV-positive population — after an initial period of decline before 2001 — increased by 43% (from 90 to 129 per 100,000) between 2001 and 2006. Of all patients hospitalized with stroke, 0.09% were HIV-positive in 1997 and 0.15% were HIV-positive in 2006. This increase in the proportion of patients with HIV infection was seen for ischemic stroke but not for subarachnoid or intracerebral hemorrhage. During the study period, the prevalence of other risk factors for stroke, such as hypertension, increased in the HIV-infected population.

Comment: Although this study shows that a growing proportion of patients hospitalized for stroke are HIV-infected, it does not tell us why. The finding may be related, in part, to the fact that HIV-infected patients are now living long enough to develop complications such as stroke. Moreover, risk factors for stroke may be more common in HIV-infected patients than in the general population — this is certainly true for smoking. The authors speculate that HIV infection, metabolic derangements, or antiretroviral medications could be contributing to risk for stroke, but more research is needed before firm conclusions can be drawn.

— Rajesh T. Gandhi, MD

Published in Journal Watch Infectious Diseases February 9, 2011

Citation(s):

Ovbiagele B and Nath A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology 2011 Feb 1; 76:444.

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