Rates of Stroke in HIV Patients Highest Among Women


A proposed mechanism underlying observed sex differences in HIV-associated vascular risk is increased immune activation in women.

Rates of stroke are higher among people living with HIV (PLWH) compared with age-matched HIV-negative patients, and this increased risk of stroke has been observed in numerous studies.

Since these studies relied largely upon data from electronic medical records and did not follow patients at regular intervals, the potential for incomplete and inaccurate information remains. Felicia Chow, MD, a board-certified neurologist and neuro-infectious disease specialist at the University of California San Francisco, collaborated with several colleagues and investigated the incidence of first-ever stroke/transient ischemic attack (TIA) and associated risk factors in a cohort of persons living with HIV infection (PLWH).

The study authors utilized the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) study, a cohort study of HIV-infected subjects prospectively randomized into selected clinical trials for antiretroviral (ARV) treatment-naïve and ARV treatment-experienced individuals. This prospective, observational cohort study followed patients at a minimum of once every 12 weeks until the completion of the parent protocol and then every 16 weeks thereafter. Patients were excluded if they experienced a stroke prior to the study.

The primary endpoint of the study was a composite of first-ever stroke or TIA. Other data collected during the study included hypertensive status, low density lipoprotein (LDL) cholesterol levels, statin use (previous 12 months), previous myocardial infarction (MI), history of diabetes mellitus, smoking status, BMI, waist circumference, renal function, hepatitis C virus (HCV) infection status and history of intravenous drug use. Malignancies of the central nervous system (CNS) were also noted.

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