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Strokes, TIA more common among female, black HIV patients

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BOSTON — Data presented here at CROI 2016 suggest that among HIV patients, women and non-Hispanic blacks are more likely to have a stroke or transient ischemic attack.

“Several large cohort studies have identified increased rates of stroke among persons with HIV when compared with age-matched uninfected controls,” Felicia Chow, MD, assistant professor of neurology at the University of California, San Francisco, said during a presentation. However, many of these cohorts are subject to numerous limitations, including a reliance on ICD codes and relative homogeneity.”

Felicia Chow

To circumvent these concerns, Chow and colleagues reviewed data from the ALLRT Cohort and its parent studies, which examined HIV patients with no history of stroke initiating ART from June 1998 to June 2011. The researchers identified the incidence of first-ever stroke or transient ischemic attack (TIA) reported at patient follow-up visits. Traditional and HIV-specific risks for these events were determined using age-adjusted Poisson regression.

There were 6,933 HIV patients included in the study, 20% of whom were women, 21% of whom were Hispanic and 37% were non-Hispanic blacks. Prior to ART initiation, the median age of participants was 37 years, the median CD4 count was 243 cells/μL and HIV RNA was 57,624 copies/mL.

Fifty-four strokes or TIAs were identified over an analysis pool of 32,023 person-years (PY). Stroke or TIA incidence among men was 1.4 per 1000 PY, while incidence among women was increased to 2.88 per 1000 PY (age-adjusted RR = 1.72; 95% CI, 0.96-3.09). Furthermore, incidence among non-Hispanic blacks was 2.51 per 1000 PY — a higher incidence than the 0.77 per 1000 PY rate recorded among Hispanics or other ethnicities (age-adjusted RR = 2.94; 95% CI, 1.22-7.14), and the 1.56 per 1000 PY rate recorded among whites (age-adjusted RR = 1.67; 95% CI, 0.95-2.94).

Other factors associated with increased risk in multivariable analysis included older age, hypertension, LDL of at least 160 mg/dL, CD4 counts of no more than 200 cells/μL and HIV RNA counts greater than 200 copies/mL. Injection drug use, HCV or recent ART were not associated with increased risk for stroke or TIA, and overweight or obese BMI was associated with a decreased risk for stroke or TIA.

“We found a trend toward higher age-adjusted incidence rates of stroke in women compared with men,” Chow said. “We also found that the incidence of stroke was higher in black participants, although only significant when comparing with the Hispanic/other race/ethnicity.” – by Dave Muoio

Reference:

Chow F, et al. Abstract 43. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: Chow reports presentation and travel support from AbbVie.