Stroke in HIV-Infected Patients in the Combination Antiretroviral Therapy Era

Both HIV and HCV infections have been associated with increased risk of stroke. We estimated incidence and mortality rates of stroke (hemorrhagic or ischemic) in HIV-infected (HIV+) patients (Pts.) in the combination antiretroviral therapy (cART) era, with particular attention to HIV/HCV-coinfected (HIV/HCV) Pts.

We reviewed the computerized data from patients in the Spanish Minimum Basic Data Set (MBDS), that includes information from Pts. discharged in almost 300 hospitals. Pts. were identified according to the following ICD-9-CM codes: HIV infection (042 or V08) with or without HCV infection (070.44, 070.54, 070.7x, or V02.62) with hemorrhagic (h) stroke (430-432) or ischemic (i) stroke (433-437). HBV infection (070.2x, 070.3x, or V02.61) was an exclusion criterion. Pts. were classified as HIV-monoinfected (HIV-Mono) or HIV/HCV. We estimated rates (events per 10,000 patient-years) in the period 1999-2011; time interval that was broken down into three periods: 1^st  (1997-1999), 2^nd (2000-2003) and 3^rd  (2004-2011). For the calculation or rates, the numerator was the number of events within each period. The denominator was the number of patient-years at risk within each period, for this purpose we estimated the number of HIV+, HIV/HCV, and HIV-Mono Pts. in each period.

h-stroke rates: In the 1^st period rates of h-stroke were higher for HIV-Mono Pts. than for HIV/HCV Pts. From the 1^st to the 2^nd period, rates of h-stroke decreased in HIV-Mono Pts. (from 16.0 to 5.5; P<0.001) and increased in HIV/HCV Pts. (from 1.3 to 7.6; P <0.001). In the 3^rd period, rates of h-stroke were higher for HIV/HCV Pts. than for HIV-Mono Pts. (Figure 1A). i-stroke rates: Similar trends were found for i-stroke. Rates decreased significantly from the 1^st to the 3^rd period in HIV-Mono Pts. (from 27.7 to 16.4; P <0.001), and increased significantly in HIV/HCV Pts. (from 1.8 to 12.6; P <0.001) (Figure 1B). Mortality rates: mortality rates for both h-stroke and i-stroke were higher for HIV-Mono Pts. than for HIV/HCV Pts. in the 1^st period; however, this trend was reversed by the 3^rd period (Figure 1C & 1D). The adjusted likelihood of death for h-stroke in the 3^rd period was higher for HIV/HCV Pts. than for HIV-Mono Pts.

Conclusions: In the cART era, incidence and mortality rates of stroke decreased in HIV-Mono Pts. but increased steadily in HIV/HCV Pts.