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Stroke incidence is highest in women and non-Hispanic blacks living with HIV in the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials 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
Clinical Science

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. Incidence rates were highest in women (2.88 stroke/TIAs per 1000 person-years compared with 1.40 per 1000 person-years in men) and non-Hispanic Blacks (2.51 stroke/TIAs per 1000 person-years compared with 0.77 per 1000 person-years in Hispanic/other race/ethnicities and 1.56 per 1000 person-years 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, whereas 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 greater than 200 copies/ml. Overweight/obese BMI and higher CD4+:CD8+ ratio protected against stroke/TIA.

Conclusion: 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 multipronged approach targeting vascular risk factors and engaging and retaining patients in HIV care.

aWeill Institute for Neurosciences

bDepartment of Neurology and Division of Infectious Diseases

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

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

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

fDepartment of Medicine, Division of Infectious Diseases, Boston University, Boston, Massachusetts, USA.

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, USA. E-mail: felicia.chow@ucsf.edu

Received 14 September, 2017

Revised 20 December, 2017

Accepted 8 January, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).

Copyright © 2018 Wolters Kluwer Health, Inc.