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Stroke incidence is highest in women and non-Hispanic Blacks living with HIV in the ALLRT cohort

Chow, Felicia, C.a,b,*; Wilson, Michael, R.a,c,*; Wu, Kunlingd; Ellis, Ronald, J.e; Bosch, Ronald, J.d; Linas, Benjamin, P.f

doi: 10.1097/QAD.0000000000001799

Objective: To investigate the incidence of first-ever stroke/transient ischemic attack (TIA) and associated risk factors in a cohort of persons living with HIV infection (PLWH).

Design: Observational cohort study

Methods: We determined incidence rates of first-ever stroke/TIA in PLWH after ART initiation from the AIDS Clinical Trials Group ALLRT cohort and its parent trials. Poisson regression models evaluated baseline and time-varying covariates as risk factors for stroke/TIA.

Results: The incidence rate of stroke/TIA was 1.69 per 1000 person-years (PY). Incidence rates were highest in women (2.88 stroke/TIAs per 1000 PY compared with 1.40 per 1000 PY in men) and non-Hispanic Blacks (2.51 stroke/TIAs per 1000 PY compared with 0.77 per 1000 PY in Hispanic/other race/ethnicities and 1.56 per 1000 PY in Whites). In a multivariable model, we found a significant age-by-sex interaction (p = 0.01). The higher risk of stroke/TIA in women was more pronounced at younger ages, while older age conferred a greater increase in stroke/TIA risk in men than women. Other risk factors for stroke/TIA included hypertension, higher LDL, and HIV RNA >200 copies/mL. Overweight/obese BMI and higher CD4:CD8 ratio protected against stroke/TIA.

Conclusions: Women and non-Hispanic Blacks living with HIV had the highest incidence rates of stroke/TIA. A concerted effort must be made to include PLWH from these at-risk groups in observational and interventional studies aimed at understanding stroke mechanisms and reducing stroke risk in HIV infection. Strategies to modify stroke risk in PLWH should employ a multi-pronged approach targeting vascular risk factors and engaging and retaining patients in HIV care.

aWeill Institute for Neurosciences, University of California, San Francisco, CA

bDepartment of Neurology and Division of Infectious Diseases, University of California, San Francisco, CA

cDepartment of Neurology, University of California, San Francisco, CA

dCenter for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA

eDepartments of Neurosciences and Psychiatry, University of California, San Diego, CA

fDepartment of Medicine, Division of Infectious Diseases, Boston University, Boston, MA.

*Contributed equally.

Correspondence to Felicia C. Chow, MD, MAS, University of California, San Francisco at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110. E-mail:

Received 14 September, 2017

Revised 20 December, 2017

Accepted 8 January, 2018

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