Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

Jan H Schaefer; Christoph Stephan; Christian Foerch; Waltraud Pfeilschifter

doi:10.1177/2396987320927672

Ischemic stroke in human immunodeficiency virus-positive patients: An increasingly age-related comorbidity?

Eur Stroke J. 2020 Sep;5(3):252-261. doi: 10.1177/2396987320927672. Epub 2020 Jun 3.

Authors

Jan H Schaefer¹, Christoph Stephan², Christian Foerch¹, Waltraud Pfeilschifter¹

Affiliations

¹ Department of Neurology, Goethe University, Frankfurt am Main, Germany.
² Department of Internal Medicine, Infectious Diseases Division, Goethe University, Frankfurt am Main, Germany.

Abstract

Introduction: The global incidence of ischemic stroke among patients with human immunodeficiency virus is increasing. The aim of this controlled case analysis was to study patient characteristics, stroke etiologies, and risk factors in human immunodeficiency virus-positive patients in a medical system with easy access to antiretroviral therapies.

Patients and methods: We conducted a retrospective, observational study of human immunodeficiency virus-positive patients treated in our stroke unit and outpatient clinic in Germany between 2012 and 2018. A control group of all patients treated for acute ischemic stroke in 2018 was used to elicit possible differences in stroke localization, etiology, and distribution of risk factors.

Results: Out of 3615 patients with an acute ischemic stroke, 24 (0.7%) were newly or previously diagnosed as human immunodeficiency virus-positive. Strokes in this cohort were caused by large-vessel disease (37.5%), small-vessel disease (20.8%), cryptogenic-embolism (20.8%), vasculitis (16.7%), and cardio-embolism (4.2%). Large-vessel disease-related strokes were more often located in the posterior circulation (77.8%). Compared to the control group, cardio-embolic strokes were less and vasculitis and large-vessel disease more frequent. Human immunodeficiency virus-positive patients were younger at stroke onset (53.7 ± 12.8 vs. 70.2 ± 14.6 years, p = 0.05).

Discussion: Although the prevalence of human immunodeficiency virus-infection among patients treated for acute ischemic strokes appears low, this collective merits special attention due to a high burden of potentially modifiable risk factors and vasculitis.

Conclusion: Compared to previous studies, age at stroke onset was one of the highest, supporting the hypothesis that as antiretroviral therapy increases the life expectancy of people living with HIV/AIDS, they will be increasingly affected by cardiovascular disease. Human immunodeficiency virus-related cerebral vasculitis was associated with high mortality (75%).

Keywords: HIV; Stroke; age; cardiovascular risk; vasculitis.